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ILECTRIC PERMIT A)PLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> - 3200 CEDAR STREET, EVERETT, WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 I (E) everetteps@everettwa.gov I www.everettwa.gov/permits <br /> • JECIT SITE MOON 1,111414-S " - <br /> PROJECT ADDRESS: I0 CV-6/5 ree.,A_ 4t, jCare41-(tiS Pee 7L.4o bOei <br /> BUILDING AREA(if residential,new construction, remodel, or addition) 1 SF <br /> BUILDING TYPE: 0 SFR-DETACHED 0 SFR-ATTACHED 0 DUPLEX 0 MULTI-FAMILY-#OF UNITS: gCOMMERCIAL <br /> ELECTRICAL APPLICATION INFORMATION ' <br /> CONTRACT PRICE OF WORK:$ u(-7 <br /> NUMBER OF DEVICES(if low voltage): <br /> FIRE ALARM? 0 YES 0 NO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIPTION OF WORK: LA deAIt 'Deci CZ -c\POivt 4? 7t4e•( 4-0 <br /> 11- WWN- CA A4 h9( IP` vt-e( C(9 Ate,44," k P ci- <br /> r <br /> - - S coNi-Aer itiFoknaTtdri <br /> OWNER NAME: S ( A44 , L1 TENANT NAME(If Commercial): Skatitt tied-to 1 <br /> OWNER MAILING ADDRESS: STREETe2 Z..4 , j-rel <br /> crrY vf4 STATE (A) ZIP <br /> 8,203 <br /> OWNER PHONE: 112.5 3g3-2,3 _OWNER EMAIL: <br /> , <br /> CONTRACTOR NAME: (V\0 s Or\ £1-0,4-ria 1, L <br /> CONTRACTOR ADDRESS: STREET A) 7'( ' <br /> n I <br /> CITY tAAQr-tis 0,t Ct-e- STATE c")A ZIP qe?._-26 <br /> CONTRACTOR PHONE: 61 253CIS--(0 d CONTRACTOR EMAIL:1A/0 <br /> c•ik 6 elee+Ne I SO 8 fAA. :( <br /> CONTRACTOR LIC.NREQUIRED): A-Lek) c. Lic CITY OF EVERETT BUSINESS L1C.#(REQUIRED): 6(5'4 ( <br /> PRIMARY CONTACT: 0 OWNER , CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: 11,2S-3/...ec---69 .3 <br /> CONTACT EMAIL: Ma s‘on e Ice>LAA,g,'( <br /> AGREEMENT:V.hereby certify that I have read and examined this application and know the same to be true and correct. All provisions of laws and ordinancg.a.overning this <br /> type of work will be completed whether specified herein or not. The granting of a permit does not presume to give authority to violate or cancel the provisions of any other state or <br /> local law regulating construction or the performance of construction. That/am authorized by the owner of this property to perform the work for which application is made and I <br /> comply with the State Contractors Law 18.27 RCW and 296.200 WAC. <br /> City of Everett Official Use Only <br /> FEE <br /> S9- _ So <br /> PERMIT# <br /> E g 03 - C) <br /> ,20 <br /> wnerlA h rized Agent ignature Date (Revised 10/12/2015) <br />