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477 _ECTRICAL PERMIT AILICATION <br /> CITY 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.gov I www.everettwa.govlpermits <br /> PROJECT SITE INFORMATION <br /> PROJECT ADDRESS: 3700 cec ..i•c_A( A&e , Eu 4 reit (jcA 902 c,( <br /> BUILDING AREA(if residential, new construction,remodel,or addition) 7g, COO SF <br /> BUILDING TYPE: 0 SFR-DETACHED 0 SFR-ATTACHED ElDUPLEX 0 MULTI-FAMILY-#OF UNITS: r COMMERCIAL <br /> USE OF BUILDING: -(e'v‘A.-.€v\tffc--.0.. SG,kOo <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK: $ 374 71-10 38 <br /> NUMBER OF DEVICES (if low voltage): <br /> FIRE ALARM? 0 YES NI NO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): a ((�� <br /> DESCRIPTION OF WORK: Ad. Acc- Ccmr l -Ix <br /> -fr3 c:400 cs . iArAcX q <br /> 1 UAC i(v_3.).:4-S 4e) 3 + -E-e rccmi 6 mac,t"c es , <br /> (� CONTACT INFORMATION <br /> OWNER NAME: GLer� " 1'u.S t c 5'1,0�tS TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET -3 90C) {3 <br /> `` <br /> CITY G 0er-e X- <br /> ,JC. <br /> STATE I � ZIP ` &'ZOI <br /> OWNER PHONE: '-t25-tZ�- 355- 1-1 19 L/ OWNER EMAIL: YV1,j L IN i e ec-e C el.9e l`e-i4-c, G e <br /> CONTRACTOR NAME: k)e-tScrel g(E?C1C 1,G .L►►-,,C, ee <br /> CONTRACTOR ADDRESS: STREET Ot(O2-0 j+a-i-�e 4,...)e. nne. /V, <(,-4-e ZC1 <br /> CITY s A. l e- STA'TEE (2)C� ZIP 9q I <br /> CONTRACTOR PHONE: a 7523-LAS2.5 CONTRACTOR EMAIL: ( K;, �c,-teiGV-6)1(lelsone(ec.Lcci-0.. <br /> CONTRACTOR LIC.#(REQUIRED): 1-5 113ZGZ CITY OF EVERETT BUSINESS LIC.#(REQUIRED): OQ N?C <br /> PRIMARY CONTACT: ❑OWNER Ja CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: / - 1.4._537C, <br /> 17zAvv 14 P'-.- ' CONTACT EMAIL: & <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 1 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 /> 5��.j PERMIT# <br /> Owne ,uthorized Agent Signature late (Revised 9/23/2016) <br />