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47r ELECTRICAL PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERE1 I,WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 1 (E)everetteps@everettwa.gov( www.everettwa.gov/permits <br /> PROJECT SITE INFORMATION <br /> PROJECT ADDRESS: <br /> BUILDING AREA(if residential,new construction,remodel,or addition) SF <br /> BUILDING TYPE: DSFR-DETACHED 0 SFR-ATTACHED 0 DUPLEX 0 MULTI-FAMILY-#OF UNITS: 0 COMMERCIAL <br /> USE OF BUILDING: „')"{.- <br /> . . • <br /> • ELECTRICAL APPLICATION INFORMATION . <br /> CONTRACT PRICE OF WORK:$ 1;00. ei)j` <br /> NUMBER OF DEVICES(if low voltage): <br /> FIRE ALARM? 0 YES F .NO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): ill j?W S •- 0(4'7 <br /> �. � L j <br /> DESCRIPTION OF WORK: -tat(t --1,, Dick,e+1 t S I-F e-nc* gun-9 <br /> • <br /> CONTACT INFORMATION <br /> OWNER NAME: (1 a k.,,., i.(,L_, 4-)t)(--.4-" TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET 1 1.; ,( Oa j s (Lit- <br /> CITY ��tt 1.. ik' STATE t,( ZIP � ~ c'i� <br /> ik <br /> OWNER PHONE: ''1 1S I5Q .1 )OI OWNER EMAIL: /) I f�'L, - <br /> CONTRACTOR NAME: Sr 1ct.flc)co1� ei ' rlLA- i ti:i' , .rl.' ry.. <br /> CONTRACTOR ADDRESS: STREET '16 v t r1 f/ . ..F IC 1 <br /> CITY R,()) t ft.[f' 41Y1 STATE IAjei ZIP t:) ''f^ ry <br /> CONTRACTOR PHONE: 3f�c) W 3c- -7,73.3-t'''CONTRACTOR EMAIL: cS '.,(1.�4, tr.c11,4i <br /> 1, y i b �hit)^ ../q <br /> �,oyi.ei 1 ~ ., <br /> CONTRACTOR LIC.#(REQUIRED: g 1-111A)Al IAA$4? CITY OF EVERETT BUSIN SS UC.#(REQUIRE 51( <br /> PRIMARY CONTACT: 0 OWNER $'CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: `:31t,0 cp.) 7 )5C1 <br /> 6 t0/4.71 . \1-1,11 CONTACT EMAIL: Skp41' .J.1.t / .e - /A"L k ilta.rh,vf Eill,„,„ ' ) , <br /> � ftitAt+AGREEMENT:(treby cerfffy that 1 have read and examined this appltcatipn and know the same to be true and correct, Ah pm ''» of fawn and ordinancesagis typo <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!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 /> T PERMIT# <br /> Q__7tt1 t -if"I,,, ` '' S1�" 'Owner/Aurized Agent Signature Date (Revised 9/23/2016) <br />