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ELECTRICAL PERMIT APPLICATION <br /> 'Ai CITY OF EVERETT PERMIT <br /> I SERVICES <br /> 3200 CEDAR STREET, EVERE T T, WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 I (E) everetteps@everettwa.gov I www.everettwa.gov/permits <br /> Y?' PROJECT tett I FOR ATIO >' ` ':: :,. <br /> PROJECT ADDRESS: 5t 0 3 1 y C/?-63 <br /> BUILDING AREA(if residential,new construction,remodel,or addition) SF <br /> BUILDING TYPE:'FR-DETACHED 0 SFR-ATTACHED 0 DUPLEX 0 MULTI-FAMILY-#OF UNITS: 0 COMMERCIAL <br /> USE OF BUILDING: • ( %7 A <br /> :: :ELECTRIAL::APPL'�CATIO <br /> ...... . . . .:..::.. :.... ... . . : CN FOR <br /> CONTRACT PRICE OF WORK:$ <br /> NUMBER OF DEVICES(if low voltage). <br /> FIRE ALARM? 0 YES 0 NO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIPTION OF WORK: jag c 1 • , ,„ <br /> v" " l S'"`-' ` l r s• <br /> CONTACT INFORMATION <br /> OWNER NAME: i ThL2�r V 1 TEANT NA E(If Commercial): <br /> OWNER MAILING ADDRESS: STREET 1),/ 41A/. <br /> CITY STATE W1ZIPoi {—/3 <br /> OWNER PHONE:4.2- -- ti-' 13fl OWNER EMAIL: 1 l j l CA 17 1 • <br /> CONTRACTOR NAME: i A Owycak - •G y"' ` - <br /> CONTRACTOR ADDRESS: STREET 63 j"� '� 31 ' 11W S <br /> 2c� ' STATE w '� ZIP oiscloy <br /> CONTRACTOR PHONE:4 -?T 'Wad, CONTRACTOR EMAIL: itOmeetAirrypit�Cth <br /> CONTRACTOR LIC.#(REQUIRED): el I.0 CITY OF EVERETT BUSINESS LIC.#(REQUIRED)VJ 1 1 ✓ 4 <br /> PRIMARY CONTACT: 0 OWNER ZOONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME:/�� J � CONTACT PHONE: <br /> 331- 3c )\ <br /> t �r` t ! CONTACT EMAIL:Nieb fir.,CO ( , k'f 4 (jy j <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 l am authorized by the owner of this property 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 /> •C)17-Nj\- <br /> PERMIT# <br />