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I <br /> 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 1 (E)everetteps©everettwa.gov} www.everettwa.gov/permits <br /> PROD C "SITE INFO fA ' O <br /> PROJECT ADDRESS:' a •era, Q. <br /> BUILDING AREA(If residential,new construction,remodel,or addition) SF <br /> BUILDING TYPE: .,kw SFR-DETACHED 0 SFR-ATTACHED 0 DUPLEX 0 MULTI-FAMILY-#OF UNITS: 0 COMMERCIAL <br /> USE OF BUILDING: <br /> *ONO, <br /> . ' ,: 014 le 4121,j00 OXIOAt1 € ISPOR iO I <br /> CONTRACTOF WORK: • <br /> NUMBER OF DEVICES if low volta.e : <br /> FIRE ALARM? CI YES ■ NO <br /> ASSOCIATED BUILDING PERMIT# if a..licable : <br /> QESCRIPIIDI`[DF WQRK• I'99. Cit.,(2,,,e_ 41,0„..4...._ rluxcx..., 5a,b Wai . ' 0 -,.• -` <br /> OWNER NAME: A -' . LA,Dt:5t TENANT NAME(tf Commere eft <br /> OWNER MAILING:ADDRESS:_ STREET A e. a ,. <br /> STATE ZIP <br /> Cllr <br /> Ulf F}- ' 820 <br /> OWNER PHONE: 426 j rk J <br /> OWNER EMAIL: <br /> CONTRACTOR NAME: " }� �I 0 <br /> [CONTRACTOR ADDRESS sreFET } I.5ia(ocKitiocin STA �t11 a <br /> CONTRACTOR PHONE LIZ'aS1:0 � CONTRACTOR EMAIL {i t l'e �1, (L #r4,-14 <br /> v. -` NTRA 1 U ; C EOthhR b}t CITi_... <br /> Y OF EVERETT BUSINESS LIC;; QUIRED) !) <br /> PRIMARY CONTACT: 0 OWNER ,,CONTRACTOR 0 OTHER(Please Specify) <br /> {CONTACT NAME: CONTACT PHONE: tr" s 5ct <br /> CONTACT EMAIL: !f * teztn. corn <br /> AGREEM <br /> NT:I <br /> by certify <br /> I have reed and examined this application and know the same to be true and correct. Alt <br /> of work will be plwhetherrs specified herein or not. The granting of a permit does not presume to give authority to violate orcancelthe provisionsons of le-v;s end <br /> fannces governing hstate <br /> this type <br /> completedp fanyctherstatear <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 I <br /> comply with the State Contractors Law 18.27 RCW and 296.200 WAC. <br /> City of Everett Official Use Only <br /> PERMIT# <br /> k4 wait) 2 .zS• t7 E 19 92 - 210 <br /> Owner/Authorized Agent'S1ynatu Date (Revised 9/23/2016) <br />