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"IP* ELECTRICAL PERMIT APPLICATION <br /> NIIIIW1I►' CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> (P)425-257-8810 1 FAX 425-257-88571 (E) everetteps@everettwa.gov l www.everettwa.gov/permits <br /> PR®dEdT SITE INNARINIA`ldh <br /> PROJECT ADDRESS: ` ©IC 7 h D 4-Ve- T- <br /> BUILDING AREA(if residential,new construction,remodel,or addition) 1,,7 00 SF <br /> BUILDING TYPE: 0 SFR-DETACHED SFR-ATTACHED 0 DUPLEX 0 MULTI-FAMILY-#OF UNITS: 0 COMMERCIAL <br /> USE OF BUILDING: r46006t,s� <br /> ELECTRICAL APPLICATION INFORMATION. <br /> CONTRA'..... <br /> CT PRICE OF WORK:$ lzfra;:t1W1- 0/0,62.de) <br /> NUMBER OF DEVICES(if low voltage): <br /> FIRE ALARM? 0 YES IVNO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIPTION OF WORK: Re._1✓i Yom.- b(c+GLSe/E/I l►i s�T leIIC P, 1 Spec fen <br /> L6 ffey� code ssyd <br /> • <br /> CONTACT INFORMATION <br /> OWNER NAME: TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET <br /> CITY STATE ZIP <br /> OWNER PHONE: / ` �^ OWNER EMAIL: <br /> CONTRACTOR NAME: t�/ark.J GAS ci} '.e .. .,.�/�. /. ,. _. <br /> CONTRACTOR ADDRESS: STREET 73/ 2.5 d/-"/ ' S� ,4 ,/ <br /> CITY S-Gy 4 wi.o STATE 1. A ZIP q c5-17.4 <br /> CONTRACTOR PHONE: y25_76 -- ?gel- CONTRACTOR EMAIL: -- ' <br /> CONTRACTOR LIC.`#(REQUIRED)_ CI_4-P(hT �/03 ` AYW CITY OF EVERETT BUSINESS LIC Y#(REQUIRED):SYO <br /> PRIMARY CONTACT: ❑OWNER CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: ///2.5 7,0 9'E5-g'?/ <br /> T�C-cL Ua,ri& CONTACT EMAIL: <br /> AGREEMENT:T 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 <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 I 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 /> FEE <br /> ISD — <br /> PERMIT# <br /> �--' c-23r-/g/ E ts' bS,(0 <br /> wnerlAuthorized Agent Signature Date (Revised 90/9212095) <br />