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fo. �q <br /> ifitfr ELECTRICAL PERMIT APPLICATION <br /> ,441 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 www.everettwa.gov/permits <br /> PROJECT SITE INFORMATION <br /> PROJECT ADDRESS. 1 i S A <br /> r, 1 _ <br /> BUILDING AREA Of;-esideotial new:onstructtan, remodel,or addition: <br /> SF <br /> BUY DING TYPE: S=t?-DET.AGI-F-D 3=R-A.'-74;>1-I,=j 0 9J L K <br /> Lt;JI.TI-=A31rfi( V-#OF UNITS ©^,Oit;lMc`RVi.S_ <br /> USE OF BUILDING„ <br /> ELECTRICAL APPLICATION fiNFORIAtIQN <br /> CONTRACT PRICE OF WORK: $ 7 5CD t)c' <br /> NUMBER OF DEVICES (if low voltage): I <br /> FIRE ALARM? 0 YES 0 NO <br /> ASSOCIATED BUILDING PERMIT#(if apolicable)I <br /> DESCRIRTI'}N OF WORK: __ <br /> G.F , t' "► t a T <br /> IdoN;racrt t ORMATioN <br /> OWNER NAME: et,tie • £- TENANT NAME If Commercial): <br /> OWNER MAILING ADDRESS: crig f{ / <br /> \LA 711/4 <br /> r _ <br /> -STATE ,f A, VP 'fit <br /> OWNER PHONE: a=F AP r. <br /> i1�,t�ae�1 OWNER EMAIL: <br /> CDNTRA TOR NAME: " C i ,, r <br /> CONTRACTOR ADDRESS: ` <br /> STRcST I i �'"a�� 4111 . <br /> CnY '1`✓'_'4,R' ! STATEVhf A" ZIP CY3 <br /> CONTRACTOR PHONE: � 1! <br /> ° ,meq « a CONTRACTOR EMAIL: ! 'j1 ' ,**/ .i• <br /> ��oNTRAr~TOR�rc. ����t�t=o: _ r 1 � , '.KW <br /> CITY OF EVERETT BUSINESS LIC.#(REQUIRED: o 42' <br /> ►A I ! �► <br /> PRIMARY CONTACT: 0 OWNER <br /> CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: <br /> } CONTACT PHONE: liar 35q D <br /> TDO <br /> J i ),L i CONTACT EMAIL: _,ej,., <br /> • <br /> AGREEMENT:I hereby certify that 1 have read and examined this application and know the same tbeand Correct. All provisions flaws andcoornrdinances governing <br /> of work Mil be completed whether specified herein or not. The granting of a permit does not presume to glue authority to violate or cancel the provisions of any other state or <br /> local law regulating construction or the performance of construction. That t em authorized by the owner of this property to perform the work for which application is made and type <br /> comply with the State Contractors Law 18.27 ROW and 296.200 WAC. <br /> City of Everett Official Use Only <br /> PERMIT# <br /> 'e-)36 --' k 0• E \s to - 2_5 I <br /> ov+nerlAuthorixed Agent S'rgnaturo <br /> Cate <br /> (Revised 9/23/2016) <br />