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PLECTRICAL PERMIT APPLICATION <br /> I�►' , ,- 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: 401- K p�IAd v <br /> BUILDING AREA(if residential,new construction,remodel,or addition) SF <br /> BUILDING TYPE: 0 SFR-DETACHED 0 SFR-ATTACHED 0 DUPLEX 0 MULTI-FAMILY-#OF UNITS: b COMMERCIAL <br /> USE OF BUILDING: <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK:$ /c20 <br /> NUMBER OF DEVICES(if low voltage): <br /> FIRE ALARM? 0 YES 0 NO <br /> ASSOCIATED BUILDING PERMIT#(if a livable): <br /> DESCRIPTION OF WORK: J 5 I I I ( I,I Le 49er 0' VO" Gya <br /> CONTACT INFORMATION <br /> OWNER NAME: N EN L)7i TENANT NAME(If Commercial): 1 J6 OlEI <br /> OWNER MAILING ADDRESS: STREETI!V�g9. a C / J <br /> 114 <br /> CRY - Gt l i JV i". STATE (/V — ZIP ger{�� <br /> /f <br /> Lfil <br /> OWNER PHONE: Lcf) 2 1 �j OWNER(EMAIL: --17141 Al lu l? O',$‘2_,-7s-- <br /> CONTRACTOR <br /> ?S CONTRACTOR NAME: 5 P () (, <br /> CONTRACTOR ADDRESS: STREET i9/06 )..)i� <br /> CI YV)( y,� STATE (444 ZIP,37f.)Sv <br /> CONTRACTOR PHONE: 42(—27 ?.—o q 'CONTRACTOR EMAIL: /)•yvt-e� ,_S c, r <br /> CONTRACTOR LIC.#(REQUIRED): S ).3 CITY OF EVERETT BUS LIC.!REQUIRED): WU <br /> fik- <br /> PRIMARY CONTACT: D OWNER 0 CONTRACTOR 0 THER(Please Specify) VeKA9 <br /> CONTACT NAME: CONTACT PHONE: 4.2s- .273—00 7 <br /> ,-;44 ,mss 24,4 CONTACT EMAIL: ¶ J < c. <br /> AGREEMENT:/hereby certify that have read and examined this application and know the se o be true and correcpro Bions o aws 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 viol a or cancel the provisions of any other state or <br /> local law regulating construction or the performance of construction. That lam 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 /> PERMIT# <br /> ....------ <br /> 1 <br /> g E l'q 12 0103 <br /> Owner/Aut e . t Signature Dat (Revised 9/23/2016) <br />