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, HbLECTRIICAL PERMIT A '- LIICATIION <br /> /I'�0, CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> (P)425-257-8810 J FAX 425-257-8857 1 (E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> PR a JECT SITE INF a RM TIOII <br /> PROJECT ADDRESS: " d <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: KCOMMERCIAL <br /> USE OF BUILDING: � S �•� 7 <br /> ELECTRIC ;L APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK: � © ©6 <br /> NUMBER OF DEVICES(if low v•llage):• <br /> FIRE ALARM? 0 YES piN0 <br /> ASSOCIATED BUILDING PERMIT e -eplicable): <br /> DESCRIPTION OF WORK: ,41 ,,6,e.4"; c ' ' e4.1 tZ <br /> • CONTACTINFORMATIAN. :. <br /> OWNER NAME: /Ulm Aseir tom.. TENANT NAME(If Commer ' I): 'F—C <br /> OWNER MAILING ADDRESS: STREET <br /> CITY STATE ZIP <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: v!N L 6 /ti ieRxgoL �r cam C 'e6 < <br /> CONTRACTOR ADDRESS: STREET 70(< -.1?7V , 5.4 <br /> cirf / STATE /�y� - ZIP �f 7-e..`• <br /> CONTRACTOR PHONE: �-- d.21/ / ? CONTRACTOR EMAIL: ' �f' g !!!���tr `✓ <br /> CONTRACTOR LIC,#(REQUIRED): . L S 2_til EVERETT BUSINESS LIC.NREQUIR D): ��--k <br /> PRIMARY CONTACT: ❑OWNER 0 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: ' / CONTACT PHONE: `7"2 s' :5 s' <br /> t D <br /> c.„ /r CONTACT EMAIL: <br /> AGREEMENT:T hereby certify t at!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 I 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 29E200 WAC. <br /> _ City of Everett Official Use Only <br /> FEE <br /> fPERMIT# <br /> Owner/Authorized Agent Signature Date (Revised 10/1212015) <br />