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ELECTRICAL PEI_MIT iNPLICATION <br /> milay CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 j (E)everetteps@everettwa.gov j wvvnw.everettwa.gov/permits <br /> PROJECT SITE INFORMATION', <br /> . .:., . _. .. .. ,, ,,nom. . <br /> PROJECT ADDRESS: �OiQ' tNS5©Glq.e� UN) a /62- 4g c/ ( 01.3 <br /> BUILDING AREA(if residential,new construction,remodel,or addition) SF <br /> BUILDING TYPE: 0 SFR-DETACHED 0 SFR-ATTACHED 0 DUPLEX 0 MULTI-FAMILY-#OF UNITS: I COMMERCIAL <br /> USE OF BUILDING: 7W/ .i r ' ' <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK:$ /r,0-c70 ,01.3 <br /> NUMBER OF DEVICES(if low voltage): <br /> FIRE ALARM? 0 YES 0410 <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIPTION OF WORK: Zit) ,4S 11‘. t©11r w / �lsCer-4 c t 2-1-/Cti <br /> 3 (� 1 c cry llc,,c< y8'0 v <br /> �A r� � CONTACT INFORMATION <br /> OWNER NAME: £ -T �Ps C„"`�`'x TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET Col Imo\ c SS bC(ce 3�Jd -+1O Z <br /> crrr STATE IAA- ZIP 9�2O3 <br /> OWNER PHONE: ti- Le) 3 690 OWNER EMAIL: <br /> CONTRACTOR NAME: C.-\%40-n - tJ� £I2(r-I-n c_ <br /> CONTRACTOR ADDRESS: STREET )1T SC 26j-�- <br /> CITY `1'K 1(-eV'L4 .. STATE \ ZIP (IVO()•1 <br /> CONTRACTOR PHONE:2-06 4,b0 l 2_ . I <br /> LPA.- <br /> EMAIL: �L\},\ @ c_''.1 q <,ct--S ,C tn-L. <br /> CONTRACTOR LIC.#(REQUIRED): l.L I SG X77 CITY OF EVERETT BUSINESS LIC.#(REQUIRED):OS 247 <br /> PRIMARY CONTACT: ❑OWNER dd��\\I CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: rr CONTACT PHONE: 2,0b el, O <br /> CONTACT EMAIL:. r-c i 15 p c c' -- <br /> �AGREEMENT.-T hereby certify that I have read and examined this application and know the same to be true and correct. All provisions of laws and ordinances governing 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 l am authorized by the owner of this property to perform the work for which application is made and! <br /> comply with the State Contractors Law 18.27 RCW and 296.200 WAC. <br /> City of Everett Official Use Only <br /> FEE <br /> PERMIT# <br /> 0" er/ thoriz Agent Signature Date (Revised 10/12/2015) <br />