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4Err tECTRICAL PERMIT AFifiLICATION <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 I www.everettwa.gov/permits <br /> Zejritf111 . . . . ._. PROJECTSITEk,INFORMATION ,; . ,' .'fir <br /> .. <br /> PROJECT ADDRESS: ) px0 a(It3 <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: 0 COMMERCIAL <br /> USE OF BUILDING: S c AN\A- ,v\5G(Ln.F-e <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK: $ 3 0 Q , (9 0 <br /> NUMBER OF DEVICES(if low voltage): 1 <br /> FIRE ALARM? ❑YES 4Zi NO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIPTION OF WORK: V(`j,S} 'k�N ,(l e_ -i gyp SI n <br /> CONTACT INFORMATION <br /> OWNER NAME: ) ctna a n j do r'1 TENANT NAME(If Commercial): Si-a.{-e Ful <br /> OWNER MAILING ADDRESS: STREET PO f'o x. 5 22-60 <br /> CITY F/VLfs-e STATE V\AV 1 ZIP g O 2O 1,, <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: gt,(/-�.� i 6,,cor p4 c�J <br /> CONTRACTOR ADDRESS: l STREET �(,(,Q fk-V1A.4.1/ '7 5 <br /> CITY ,IA()LJ(\{ V Artft ati STATE 'N/ zIP 9 8-3:7 3 <br /> CONTRACTOR PHONE:. (,(,Q-L17,i4-1-3"a-5 CONTRACTOR EMAIL: 5-k---Q„ Gt N-% 0 nAt.41-t;r-S1"-e L,GVr,•t <br /> CONTRACTOR LIC.#(REQUIRED): (Vl•`GVI �S(�•3ZL8" CITY OF EVERETT BUSINESS LIC.#(REQUIRED): `j 7 �j 1 <br /> PRIMARY CONTACT: ❑OWNER KCONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: '3(j 0--L f 2,4 S <br /> n 4 <br /> CONTACT EMAIL: Sit/4 yvi..6,Leri-stIn z 0/1,1 <br /> AGREEMENT:I hereby 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 1 <br /> comply with the State Contractors Law 18.27 RCW and 296.200 WAC. <br /> City of Everett Official Use Only <br /> PERMIT# <br /> � � <br /> E1 Z � , � r2c1 o <br /> • e • • e• •gen •'s nature D9te { (Revised 9/23/2016) <br />