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ELECTRICAL PERMIT APPLICATION <br /> ii i CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 I (E) everetteps@everettwa.gov I www.everettwa.gov/permits <br /> PROJECT SITE INFORMATION <br /> PROJECT ADDRESS: 0,0-.1 f\ 2\t0\c \\JQ-. <br /> BUILDING AREA(if residential,new construction,remodel,or addition) ‘2e"f7 SF - <br /> BUILDING TYPE: 0 SFR-DETACHED 0 SFR-ATTACHED 0 DUPLEX 0 MULTI-FAMILY-#OF UNITS: XCOMMERCIAL <br /> r <br /> USE OF BUILDING: Cc r\ <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK:$ k 1 5-6 O <br /> NUMBER OF DEVICES(if low voltage): <br /> FIRE ALARM? 0 YES I'NO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): ` i <br /> DESCRIPTION OF WORK: .f.(AMA_ N.4)0,�,r� 0..C3-k 5'�it 'Q-S I C Jck 4 <br /> -Ff)K" .51 K-k> <br /> ;CONTACTIINFORMATION. :. ,," �"� <br /> OWNER NAME: rs; -'f�i%!�'�"'”rI _-,,,---""z.. — TENANT NAME(If Commercial): `BkZUICL Jut It, wV�2cc.r�.' <br /> OWNER MAILING ADDRESS: STREET 1 p`7 A fA '�'� kvte__, _1 <br /> erre F-VV.ro ' l STATE Y V /Q „q2)()(.� <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: \\\)A-kf ``VAda\c\ . <br /> CONTRACTOR ADDRESS: STREET `� I .)b'r.Wrh a <br /> \`r CITY � ST/ATE q(o��-5 ZIP <br /> CONTRACTOR PHONE:x`25 IAAvo\\ CONTRACTOR EMAIL: Ck),.) \\h` i. t\`�V`C. ,Atk,toy\CONTRACTOR LIC.#(REQUIRED): aIU. 03j CITY OF EVERETT BUSINESS LIC.#(REQ26IRED): l` J O <br /> _._ ,:�. T..� ,..,,, . _.,n. ,�..,, ...n ...�_ ,,,T: r.,...r. �.w:: v...... u..:n:.._ __ y- �.r.....� ,. _. ::.,.. ,.„.._., K -y..a.�,._ _ r.a,....,__nkx........_ ,.,.... <br /> PRIMARY CONTACT: DOWNER 0 CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: 42c-i - Le I-frT �r . L <br /> (�� 'fj:WJ �Z CONTACT EMAIL-1110_4- (C - I P la C�( .M1CCLS- nc <br /> AGREEMENT:T ereby cerf thhatt I havereadand examined this application and know the same to be true and correct. All provisions of laws and ordinances governing this <br /> type of work w1 a 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 I <br /> comply with the State Contractors Law 18.27 RCW and 296.200 WAC. <br /> City of Everett Official Use Only <br /> FEE <br /> . g 2 �S d <br /> PERMIT# <br /> Jô ( z.oc2 E 1 o , ck-C <br /> Owner/Auth/f/F <br /> tSignature Date (Revised 10/12/2015) <br />