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ELECTRICAL PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT,WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 ((E)everetteps everettwa.gov I vww,everettwagov/perrmits <br /> � > . . � � b ... � $ . e Sa d z ,- >>,,, ,eQe .t , . kA s . <br /> PROJECT ADDRESS: 4 <br /> sato eN 03.1 AIDS „re,•t+' <br /> BUILDING AREA(if residential,new construction,nernodel,or addition) go0 SF <br /> BUILDING TYPE: 0 SFR-DETACHED 0 SFR-ATTACHED 0 DUPLEX 0 MULTI-FAMILY-#OF UNITS: " COMMERCIAL <br /> USE OF BUILDING: 371elte,10 o ...°t"'441/4n. Tr 0.4.444-c.c_ <br /> �'.a3,."'r•'�.�.�` �..,,,. ;i�.,, ,..,r��u 3 �'a�.�"�,n.��.� ,. Iw r *,• ......, .. <br /> CONTRACT PRICE OF WORK:$ �OQ.00 <br /> NUMBER OF DEVICES(if low voltage): <br /> FIRE ALARM? 0 YES t3 <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIPTION OF WORK: :: ° <br /> t�v � f� Last r ['t� C3 P" �e r� s�rvc.'"� <br /> OWNER NAME: A-9 '.. • - t;` TENANT NAME(If Commercial): . <br /> OWNER MAILING ADDRESS: STREET I tk.k.i iy • D ,s-r .. –201 g �jq� <br /> Cr#V' y64 0 o 4I STATE +P"" ZIP '4/11 Z 10 <br /> OWNER PHONE: OWNER EMAIL: , <br /> _ , ... . —,–,..,,,, <br /> CONTRACTOR NAME: ,`,1 u I e_ E lee i t <br /> CONTRACTOR ADDRESS: STREET o `.A 4 g(c, p{y <br /> CITY f r o " STATE b ' t ZS g f <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: C$„ts h to brP e fit•L44 is • n <br /> CONTRACTOR LIC,#(REQUIRED):is A y VX.I.L .. _CITY OF EVERETT BUSINESS LIC.#(REQUIRED): 1(Z(o , <br /> PRIMARY CONTACT: 0 OWNER ot.CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: 'CONTACT PHONE: efiz -2-9 zo <br /> Ch CONTACT EMAIL:(lbw.). <br /> AGREEMENT'T hereby cult' that I have read and examined this application and know the same to be true and correct Ail provisions of laws And ordinances governing this , <br /> type of work wilt 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 /> lei law feting constructionor the performance of construction. That lam authorized by the owner of this property to perform the work for which application is made and l <br /> comply with the Slate Contractors Law t&27 AM and 295.200 WAC. <br /> City of Everett Official Use Only <br /> FEE <br /> 4 6ri , 571), i <br /> PERMIT# <br /> 41-140,16 E i l'; 'OO 1 <br /> owner/Authorized Agent Signature ° Date (Revised 102/2015) <br />