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jow 1LECTRICAL PE ITLIC/T O <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> (P)425-257-8810 1 FAX 425-257-8857 1 (E) everetteps@everettwa.gov l www.everettwa.gov/permits <br /> PROJECT SITE INF®RMATION <br /> PROJECT ADDRESS: i 1 Z j � .x t^,Cr� Yl\o+ \ <br /> BUILDING AREA(if residential,new construction,remodel, or addition) 3©o SF <br /> BUILDING TYPE: 0 SFR-DETACHED 0 SFR-ATTACHED 0 DUPLEX 0 MULTI-FAMILY-#OF UNITS: N COMMERCIAL <br /> USE OF BUILDING: o, <br /> ECTRICAL,APP ICAT1ON II�FORIVlATI®i� <br /> CONTRACT PRICE OF WORK%`, Zoo' <br /> NUMBER OF DEVICES(if low'',oltage): -3 <br /> FIRE ALARM? 0 YES ■ <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIPTION OF WORK: KA,X";(NA. 3 S rv..ry l t, .s- - x ,,c k • <br /> • <br /> CONTACT INFORMATION.. <br /> OWNER NAME. TENANT NAME(If Commercial): <br /> ..J� J <br /> OWNER MAILING ADDRESS: STREET <br /> CITY STATE ZIP.. <br /> OWNER PHONE: OWNER EMAIL: <br /> . . <br /> CONTRACTOR NAME: �' C°l :,.. e• C-11 r-“:), a v . . , <br /> CONTRACTOR ADDRESS: STREET 0 �1?ej c.. g x`25 ! ) <br /> CITY\ �\\ QC'.€tL\ STATE tj <br /> ZIP <br /> CONTRACTOR <br /> CONTRACTOR PHONE:11 -4106- dao CONTRACTOR EMAIL: Cr(`j•g E/2 Q k0 `'1 /6 7 -, <br /> CONTRACTOR LIC.#(REQUIRED):r, , c ZC"`"6. 6 6C CITY OF EVERETT BUSINESS LIC.#(REQUcol <br /> PRIMARY CONTACT: I]OWNER CONTRACTOR 0 OTHER(Please Specify) / ' /� <br /> CONTACT NAME: CONTACT PHONE: 2CO b- '�I - 3 I Zf� l (\f1 , <br /> J <br /> C /o+ 4-, CONTACT EMAIL: CIA I, , Q 2C-�( (�j Gin° <br /> AGREEMENT:Thereby certify 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 <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 l 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 /> PERMIT# <br /> 71 1 lG <br /> Owner/Authorized Agent Signature Date (Revised 90/92/2095) <br />