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ELECTRICAL PERMIT ALICATION <br /> 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/perrlits <br /> PROJECT SITE INFORMATION <br /> PROJECT ADDRESS: c <br /> 1�U IZOC rC.�e.Ite_v- 4U E FtterC'f'4'7 to A `?e20 <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: COMMERCIAL <br /> USE OF BUILDING: Med cc.( O cG Ds.:WI") <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK:$ 2,000.2= <br /> NUMBER OF DEVICES(if low voltage): <br /> FIRE ALARM? 0 YES 100 <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIPTION OF WORK: ax* <br /> t IL( � � G;�'�`(,.a_t f�s / C C.c.�--I-i h rj e ►-1 �( ©(.v�P <br /> Le-vc- & -e.. 'ISO A40 t `'l f^C�eel��i✓rsvt .O r i <br /> CONTACT INFORMATION <br /> OWNER NAME: ?I`QU;cl2v►cc kp5i0v141 4.(etirid TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET 1 SC)( Li vj J- SLC) <br /> ccv 2ev1+0,1 STATE 4)7T ZIP 4::7605--7- <br /> OWNER <br /> PHONE: 'OWNER EMAIL: <br /> CONTRACTOR NAME: IPG C4 ►;(pC{� C <br /> CONTRACTOR ADDRESS: STREET 56(g • -t-Gt 0(0E- S <br /> CIV( cj +-14- STATE GJn <br /> 24,- ZIP 9g/c)g <br /> CONTRACTOR PHONE: <br /> 04,`143 0-52o0 'CONTRACTOR EMAIL: <br /> CONTRACTOR LIC.#(REQUIRED): (/EGQ F s-q2 <br /> • - CITY OF EVERETT BUSINESS LIC.#(REQUIRED): (b91 y6- <br /> PRIMARY CONTACT: ❑OWNER 0 CONTRACTOR ` THER(Please Specify) ,'c.(c( Ccs j Forr_444.-7 <br /> CONTACT NAME: <br /> (( CONTACT PHONE: 2.�( g� 7 3 9 <br /> Jl`l SCktt7t1, <br /> CONTACT EMAIL: c� jj nn <br /> AGREEMENT I herebcertify `'t ��Chwf.:ldT�� �� .�� <br /> that I have read and examined this application and know the same to be true and correct. All provisions of laws and 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 state or <br /> local law regulating construction or the performance of construction. That!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 296.200 WAC. <br /> City of Everett Official Use Only <br /> PERMIT# <br /> ~'L. �� 12c ..._ <br /> Own /Authors d Agent Signaturev E �� <br /> ate (Revised 9/23/2096) <br />