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ELECTRICAL "ERMIT APPLICATION r 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 /> PROJECT:SILTE INFO MATIOt�::: ;. ,<• ... <br /> PROJECT ADDRESS: (0 140 , 6lwA-w /r 1.n G, '�41 <br /> BUILDING AREA(if residential,new construction,remodel,or addition ' VV'r, �J� <br /> SF <br /> BUILDING TYPE: 0 SFR-DETACHED 0 SFR-ATTACHED 0 DUPLEX 0 MULTI-FAMILY-#OF UNITS: OMMERCIAL <br /> USE OF BUILDING: sVtg <br /> / _ <br /> ......: :.. ::.ELECTRICAL;APPLICATION INFORMATION: ::: <br /> CONTRACT PRICE OF WORK:$ a DO 0 <br /> NUMBER OF DEVICES(if low voltage): <br /> FIRE ALARM? 0 YES 0 NO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): O <br /> DESCRIPTION OF WORK: l /` O . ' 17) NiEw <br /> (A)T9 t4 l l I�S'r an <br /> re 1a Dv1Pn- PC-PA-VA 3bk) <br /> ';:CONTACT INFORMATION <br /> OWNER NAME: - ' `- lcl0,00/ TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: sTREEr 7 Lo5 fin)M,DIM'1 1 -P 14E <br /> CRY f STATE <br /> CIA- <br /> � N^� ZIP 2 <br /> 0 <br /> 5 <br /> OWNER PHONE:WU m91 OWNER EMAIL: (1' 1ya � Gyftoryl <br /> CONTRACTOR NAME: At <br /> 1 <br /> CONTRACTOR ADDRESS: STREErT/\/ I i �f <br /> c ..�V T STATE IN ZIP q ✓, .. <br /> CONTRACTOR PHONE: 1.4,1 'fop 'CONTRACTOR EMAIL:ADrr \(iptlyCLulnyvi. C()YY, <br /> CONTRACTOR LIC.#(REQUIRED): ► 1 , IAPS06O`1. ICITY OF EVERETT BUSINESS LIC.#(REQUIRED)0-1011).1q, <br /> PRIMARY CONTACT: D OWNER ONTRACTOR D OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE:4-T5 <br /> J U E KLAN wA N CONTACT EMAIL: rn 16(0) M'e CiAgrlo tn/‘ , <br /> AGREEMENT:T hereby certify that/have read and examined this application and know the same to be true and correct. All provisions of laws and ordinances governing this <br /> type 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 l am authorized by the owner of this properly to perform the work for which application is made and <br /> comply with the State Contractors Law 18.27 RCW and 296.200 WAC. <br /> City of Everett Official Use Only <br /> FEE <br /> t)..e--'3 <br /> PERMIT# <br />