Laserfiche WebLink
i*"7- ELECTRICAL PERMIT APPLICATION <br /> CITY OF EVE-REIT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> (P) 425-257-8810 ; FAX 425-257-88.57 ( (E.)every}taps@everett,nra.gov( www.everettwa goy/permits <br /> PROJECT SITE,INFORMATION <br /> PROJECT ADDRESS <br /> '�1ID+IC.AR Ali <br /> TYPE' ": "_TA.� c,D La i= 1 -'_1. -�s�r 11 ) '__v ❑ t=ri_ =.kat,;-v ,;4- <br /> -_„. afro-�� <br /> ELECTRICAL-APPLICATION INFORMA:TION <br /> CONTRACT PRICE OF WORK: $ 'i ` <br /> NUMBER OF DEVICES (if low voltaga): <br /> FIRE ALARM? 0 YES 0 NO <br /> ASSOCIATED BUILDING PERMIT#(t,applicable); <br /> __ F.scaIL'TIo1 OF_WORK: _ —. _ <br /> doM rAcr:r'.FORMkrIbw <br /> TENANT NAME If Commarvial <br /> OWNER MAILING ADDRESS: 1(00% ')f t j,,,_e <br /> m- iTA ‘A/A A EP t 320 <br /> t <br /> OWNER PHONE: gj +"'i (.0 OSI. OWNER EMAIL: <br /> CONTRALCTOR NAME:: Ps E". .t,)r^ <br /> CDUTRACT R ADDRESS. 1 t <br /> >T- _; Tape)alt, ,e .. <br /> 4 <br /> crry , - <br /> .,...� . syArs , A- 97. 20 <br /> CONTRACTOR PHONE; a,,,,,, ...,,;,,,-q COt CONTRACTOR EMAIL: I 'AA <br /> 4. <br /> :OTt1TCTOF. LtuiE€}: E .e41Lt t r -+� 114'(({` 11_.___ .._.. _cfr OF EVERETT BUSINESS LIC.##REQUIRED): IIQ0`4111' ► -_t <br /> PRIMARY CONTACT: 0 OWNER ,,CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: <br /> CONTACT PHONE: QS 35q +.c <br /> I '�ai. CONTACT EMAIL: �i,., ' : let-earl <br /> rte,,, <br /> AGREEMENT:I hereby certify that I have read end examined this application and know the sametrue end correct. All provisions nso laws and doordi�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 stale or <br /> local law regulating construction or the performance of construction. That 1 am authorized tying 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 Cfliclaf Use Cnly <br /> PERMIT# <br /> �11t V-) .22.‘t, <br /> E a <br /> CwnartAu#tzarixetl (gent Slgrxatura ��10- l2_ <br /> Cate <br /> CCCC��®® <br /> (Revised 9123/2016) <br />