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PLECT ICAL 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 I www.everettwa.gov/permits <br /> PROJECT SITE INFORMATION': <br /> PROJECT ADDRESS: 5'200 ��, 4.b <br /> BUILDING AREA(if residential, new construction,remodel,or addition) /0007 SF <br /> BUILDING TYPE: 0 SFR-DETACHED 0 SFR ATTACHED 0 DUPLEX 0 MULTI-FAMILY-#OF UNITS: jIRCCOMMERCIAL <br /> USE OF BUILDING: (1, <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK:$ /$"DSO <br /> NUMBER OF DEVICES(if low voltage): <br /> FIRE ALARM? 0 YES >NO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIPTION OF WORK: '��. . - a �/s ic.es. /1 �-, <br /> 2oc2 4 z ool% V / <br /> CONTACT INFORMATION. <br /> OWNER NAME: r�re.: FC9/c/ TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET no CSI 1 (/e(5�'�,,�i /A y <br /> CITY /�. -e -/ T' STATE &Ill ZIP %E 0 3 <br /> OWNER PHONE: ger- 35---; -7D 1 OWNER EMAIL: <br /> CONTRACTOR NAME: 13 K E/�/ec.4(et_ <br /> / <br /> CONTRACTOR ADDRESS: STREET oZ/0 el /1/f; /y/ f 7t( /� <br /> CITY / ,! ja STATE ti ZIP f leo <br /> CONTRACTOR PHONE: 4ZJ 70ep 67O CONTRACTOR EMAIL: .Ki� f iec4t`l� t /� <br /> / �1 <br /> CONTRACTOR LIC.#(REQUIRED):BR/01-41 e 0/44 i CITY OF EVERETT BUSINESS LIC.#(REQUIRED): <br /> PRIMARY CONTACT: 0 OWNER XCONTRACTOR 0 OTHER(Please Specify) <br /> • <br /> CONTACT NAME: CONTACT PHONE: (414--- )o (070 . <br /> pl(ch e., CONTACT EMAIL: fryf <br /> AGREEMENT:T hereby certify that!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 Jam authorized by the owner of this property to perform the work for which application is made and 1 <br /> comply with the State Contractors Law 18.27 RCW and 296.200 WAC. <br /> City of Everett Official Use Only <br /> FEE <br /> 6Z;', <br /> / — PERMIT# <br /> E 1(6 b (61 <br /> OwnerlAuthori -d Agent Signature Date (Revised 10/12/2015) <br />