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00fEn' ELECTRICAL PERMIT APPLICATION <br /> 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 ADDRESS: VI (3 W () VOMW WP1 O'12D1 <br /> BUILDING AREA(if residential,new construction,remodel,or addition) SF <br /> BUILDING TYPE: 0 SFR-DETACHED 'SFR-ATTACHED 0 DUPLEX 0 MULTI-FAMILY-#OF UNITS: 0 COMMERCIAL <br /> USE OF BUILDING: G f (I VI I� <br /> 'qqinmijjianijijir-'-qmfm,,wtm"-Arf ,-am" <br /> • ____ .,. ->_sn-:�>L H.. ���nF ____�__; ,3,6,:rs_ ,5_>,dH' V�' ...,y..n.... ..-..v. ..i... 6d ,., h�>Y` �_>u. <br /> CONTRACT PRICE OF WORK: $ 2'6 0D <br /> NUMBER OF DEVICES(if low voltage): <br /> FIRE ALARM? 0 YES ONO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIPTION OF WORK: ?0c, amp p01nV , (20 otalQ CAa ifi -fpr �QI cc <br /> a, � � EONTI ��� �iMItl+t �� ry y <br /> OWNER NAME: CAA Vic-WV/10r Cit j&MG TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET 01 IV vIGI(� V t� 4 CITY f V '1 STATE (I 1/i 1 ZIP q 2_0 1 <br /> OWNER PHONE: l/y"2.0 ) 2vio -2-I Vf OWNER EMAIL: Iv A <br /> .... <br /> CONTRACTOR NAME: 1V\ OVw/ r t,e y0U <br /> CONTRACTOR ADDRESS: STREET tV�Q <br /> Da. <br /> /� /J� <br /> CITY 1,ow r& Sn���jy�., �5STATE w 11 ZIP "`Q)2 <br /> CONTRACTOR PHONE: (11(2-t n .20- 2-017?7 CONTRACTOR EMAIL: ,V1'C/ i 1 ( olvyl <br /> CONTRACTOR LIC.#(REQUIR"E�D) NOIAE✓c �1w02_()ICI CrITY OFEVERETT BUSINESS LIC #(REQUIRED_) t, <br /> 'b <br /> PRIMARY CONTACT: 0 OWNERCONTRACTOR 0OTHER(PleaseSpecify) <br /> CONTACT NAME:� L CONTACT PHONE: (/-�-2�) (,Q(J'7"Z0� <br /> CONTACT EMAIL: (vlopn v cr,s(0maG(c . G�(M <br /> AGREEMENT:I hereby certify that I have read and examined this application and know the same to be true and correct. All provision4f laws 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 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 applic�-4on is made and I <br /> comply with the State Contractors Law 18.27 RCW and 296.200 WAC. <br /> PERMIT <br /> City#of Everett O : 1 Use Only <br /> CO° <br /> A(22�. E ��� -- (2 — <br /> Owne Authorized Agent =ignature Date (Revised 9/23/2016) <br />