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pEi i a{: (t1/4,- <br /> 4E" ELECTRICAL PERMIT APPLICATIL.. <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> (P)425-257-8810 1 FAX 425-257-8857 1 (E) everetteps@everettwa.gov 1 www_everettwa.gov/permits <br /> 'PROJECT'SITEE INFORMATION <br /> PROJECT ADDRESS: 3201 S -r E..} r&l3>G 5 c T e 330 l.oi(f Frnp or/YI rS. icAs5— <br /> BUILDING AREA(if residential,new construction, remodel,or addition) SF GOORkSOut+�`C <br /> BUILDING TYPE: ❑SFR-DETACHED ❑SFR-ATTACHED 0 DUPLEX 0 MULTI-FAMILY-#OF UNITS: COMMERCIAL <br /> USE OF BUILDING: <br /> ELECTRICAL APPLICATION INFORMATION' <br /> CONTRACT PRICE OF WORK:$ 5S4'3 <br /> NUMBER OF DEVICES(if low voltage): 21 <br /> FIRE ALARM? ❑YES ' NO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): n <br /> DESCRIPTION OF WORK: los-rAi_i_ L i�tai vOL:rAc,- SEC��'IT f S.(S i Etr - SEA - E 5-83Ce <br /> Su t;C 330 <br /> . <br /> '"CONTACT„NFORMATIO <br /> OWNER NAME:10A.5T.l(h i j,,T Szp.U. pr- TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET 2(2 f►y ,ett- - PA(2i 6 ;7 (AJA Q Q�/ <br /> CITY (ry" 1Pt(-\ STATE (AJA ZIP f igV�f <br /> OWNER PHONE: 36CD-q0"2r g57(p OWNER EMAIL: <br /> CONTRACTOR NAME: ARC: .)50/--) JE=C1/41Rl T'l Gga..9f5 <br /> CONTRACTOR ADDRESS: STREET (P lOOLO <br /> OAtES.pAL� v E. S� LOA <br /> `� <br /> C'TY P,irzi�J"TC1%-) STATE A S� ! <br /> ZIP 1 S-OS <br /> CONTRACTOR PHONE: 2c--2$y - 355 3 CONTRACTOR EMAiL:PAvL:Aeo sisc e 42(,r\) NS CUE iTY. C-Cryl <br /> CONTRACTOR LIC.#(REQUIRED): AROMSS&0 13 C Q. CITY OF EVERETT BUSINESS LIC.#(REQUIRED):031 Ct�S 7 <br /> . <br /> PRIMARY CONTACT: 0 OWNER rg CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: C.)b- 45- ( (-1 ', <br /> A2o(~3Sok) CONTACT EMAIL: PAUL:r'� Oi��0/0 e A /.0SOt)SCi.*(T y; e ei4 <br /> AGREEMENT..T hereby certify that 1 have read and examined this application and know the same to be true and correct. Ail provisions of laws and ordinances governing this <br /> type of work will be completed whether specilled herein or not. The granting of a permit does not presume to give authority to violate or cancel the provisons of any other state or <br /> local taw regulating construction or the performance of construction. That 1 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 1 <br /> / /72 1 <br /> PERMIT* <br /> C r--0 _ 3—(cam E ( (AOR- (? <br /> CiwnerlAuthorized Agent Signature Date (Revised 10/12/2015) <br />