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4m7r EECTRICAL PERMIT API1LICATION <br /> 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 J www.everettwa.gov/permits <br /> PROJECT*R6JEC*13Ift INFORMATION <br /> PROJECT ADDRESS: (p a O 5 E ,-17 vin(( L3aty <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: 0 O w► :o'et 1 vi,,04(( <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK: $ ,O! <br /> NUMBER OF DEVICES(if low voltage): I <br /> FIRE ALARM? 0 YES SI NO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIPTION OF WORK: r, � <br /> QV 2.6y 3i ,v <br /> CONTACT'INFORMATION <br /> OWNER NAME:.gOtO{wsovxQcc p -S TENANT NAME(If Commercial): 124 G�l Sim,/ IM <br /> OWNER MAILING ADDRESS: STREET SCx) SE go.f241.gt ckj I � ` 4 'i <br /> cm STATE L )1:1- zip 9$)_scrt <br /> OWNER PHONE: L(7 s -3'3 — fig'-I� OWNER EMAIL: <br /> CONTRACTOR NAME: <br /> CONTRACTOR ADDRESS: STREET I' 9 ctt M (4-(?j re e\ S <br /> cnv �„�.I'(/(k W bC)� STATE (_Aft ZIPg g 679 <br /> 9 <br /> CONTRACTOR PHONE: (4,)%"-- 0 -" fa(LF 3- CONTRACTOR EMAIL: \4Q OV( <br /> CONTRACTOR LIC.#(REQUIRED) ' QN ST *'O(Q(7 '?K CITY OF EVERETT BUSINES IC #REQUIREDn)(o ff <br /> PRIMARY CONTACT: ❑OWNER 0 CONTRACTOR 'OTHER(Please Specify) CI to (4� <br /> CONTACT AME: CONTACT PHONE: L/a — J� --(4 <br /> ,,d CONTACT EMAIL: -re vvyps c r Ard L O1M <br /> AGREEMENT:t he'eby 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 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 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 /> PERMIT# <br /> E ( - f '31 <br /> Owner uthorized Ag t Signet Date (Revised 9/23/2016) <br />