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P-MAN, <br /> CALL UIC <br /> ELECTRICAL PERMIT APPLICATIL.. <br /> 'AlaiCITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 1 (E) everetteps@everettwa.gav [ www.everettwa.gov/permits <br /> PROJECT SITE INFORMATION <br /> PROJECT ADDRESS: j 3ai toll �ve , <br /> BUILDING AREA(if residential,new construction, odel,or addition) 2-50° SF <br /> BUILDING TYPE: 0 SFR-DETACHED ❑ SFR-ATTACHED 0 DUPLEX 0 MULTI-FAMILY-#OF UNITS: COMMERCIAL <br /> USE OF BUILDING: . <br /> ELECTRICAL APPLICATION INFORMATION. <br /> CONTRACT PRICE OF WORK: $ I C¢ 03, 49 <br /> NUMBER OF DEVICES(if low voltage): 3 <br /> FIRE ALARM? ❑YES 'i$NO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): ' t <br /> DESCRIPTION OF WORK: ' i`�-r.c . �O�.v c)LT,f 5 ..C.�RtT7 :V.ST-E41 • 5 pcAT I 65a <br /> 8'a Fl co v <br /> L <br /> CONTACT I FOR AT N N. <br /> OWNER NAME: 2(QV!(WXtCt Ke ib t tt t� IA AM< (i►c:ommercial): <br /> OWNER MAILING ADDRESS: STREET V 1 9)p`�,1 C-b i [j' <br /> CITY STATE 7ZIP 4'8/l �..1 <br /> OWNER PHONE: IOVVNER EMAIL: <br /> CONTRACTOR NAME: A 'O 3. OA= JECtJRiT 1 Gk r <br /> CONTRACTOR ADDRESS: STREET (4,00 OAt ..D,AL E IA d . $`,� JJ J� <br /> r_ CITY pG.k:, 1 ON) STATE t.A.A `:ZIP Q5 7 <br /> CONTRACTOR PHONE:ADt 2-4 5 J 4t `CONTRACTOR EMAIL: <br /> CONTRACTOR LIC.#(REQUIRED): AROMSSC�0 i 3C ITY OLIC.#( <br /> CF EVERETT BUSINESS REQUIRED):(33i RAS" <br /> PRIMARY CONTACT: 0 OWNER 0 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NA : _ CONTACT PHONE: 2 oco- 45- i i i 4 <br /> t <br /> i� Q, CONTACT EMAIL:j, n , Im a 1 N.�1 IIAy Ay a y7)Y„ • <br /> RGRE-EMENT:T hereby certify that/have read nd examin this epphcallonand know the same.to be true and correct All provisions olfaws.a d o n.Ste 1.. <br /> type of work will be completed whether spec" herein or not. The granting of a permit does not presume to give authority to violate or cancel the provrsu, <br /> i' e <br /> local law regulating construction or the performance of construction. That l am authorized try the owner of this property to perform the work for which apptk <br /> comply with the State Contractors Law 18.27 RCW and 296.200 WAC. <br /> City of Everett Official Use Only <br /> FEE <br /> 4 I q,c'° <br /> 77 ' <br /> PERMIT# <br /> f � � � —.4.„..._______ c <br /> - <br /> OwnerlAuthorized Agent Signature Date (Revised 10/1212015) <br /> L <br />