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ELECTRICAL PERMIT APPLICATION <br /> ," y CITY OF EVERETT PERMIT SERVICES <br /> smbpor. hVki, <br /> iLy, 3200 CEDAR STREET, EVERETT,WA 98201 <br /> (P)425-25741810. ( FAX 425=25.7-8857 (E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> PROJECT SITE INFORMATION <br /> PROJECT ADDRESS: ;5-Z5 <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: 0 COMMERCIAL <br /> USE OF BUILDING: QL • <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK:$ <br /> NUMBER OF DEVICES(if low voltage): <br /> FIRE ALARM? 0 YES 0 NO <br /> ASSOCIATED BUILDING PERMIT#(If applicable): <br /> DESCRIPTION OF WORK: (.)1 Lc e..; ,y-- (Z�C C f..9 z'7— �2 G42.0-76 11€.12t- <br /> FunIC <br /> • <br /> j • CONTACT INFORMATION <br /> OWNER NAME: I�I:l. . f, A vo..k TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET . 525 LlOI(a <br /> CRY l-R.JG'c(Z.{,,"""`Lr STATE LOA, . ZIP 2 ' ( <br /> OWNER PHONE( g+'ZV) 2 — �j/(�7 -OWNER EMAIL: Ad//t <br /> CONTRACTOR NAME: eve-2 �y c4y(."rE 1 + `Q' A CI <br /> CONTRACTOR ADDRESS: STREET SI2o t'74C.7t G <br /> CIN a, [I STATE UM- zip WIC( <br /> CONTRACTOR PHONE(948-2 2S 2 3l/&(- CONTRACTOR EMAIL: k''k,-4) do, <br /> CONTRACTOR LIC.#(REQUIRED): `,SS�?1 ) - CITY OF EVERETT BUSINESS LIC.#(REQUIRED): �� <br /> PRIMARY CONTACT:e 0 OWNER I 'CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: 142 z5Z_3//t¢ <br /> -4(v .CA L-0 CONTACT EMAIL: "6, @,2.5,5"/1/7 ctieft CCI/,t4 <br /> AGREEMENT:I 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 type <br /> 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 tam 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 /> (57,4 <br /> City of Everett Official Use Only <br /> / PERMIT# <br /> - - I El9AQ04 <br /> Owner/Authorized Agent Signature Date (Revised 9/2312096) <br />