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LECTRICALPERMIT AOKICATION <br /> 444* <br /> ,-� CITY OF EVERETT PERMITSERVICES <br /> - _ <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 I (E) everetteps@everettwa.govI wwvr.everettwa.gov/permits <br /> PROJECT SITE INFORMATION. <br /> PROJECT ADDRESS: KM-S. 'p I ti F ST <br /> BUILDING AREA(if6identialnew construction,remodel,or addition) SF <br /> BUILDING TYPE: 0 SFR-DETACHED 0 SFR-ATTACHED 0 DUPLEX 0 MULTI-FAMILY-#OF UNITS: 0 COMMERCIAL <br /> USE OF BUILDING: F - .A.I,A,t -1- (_Z\.)t Nr, <br /> ELECTRICAL APPLICATION INFORMATION <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: fit--q_ G rC'o/1I'J 66-1-"vi OV LAVA <br /> CONTACT INFORMATION .: <br /> • <br /> OWNER NAME: uc.1 't LI SA (ci\HLcQ TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET 1 Q t p t Ma ST• <br /> crry _a f ( - STATE \j A, ZIP 9R2 i <br /> OWNER PHONE: 43,.5-e>7O-<oC�Ci Co OWNER EMAIL: 1.�'1-C7jt1j..D�e ,l�.�l_•C_pf<il.., .... ., <br /> CONTRACTOR NAME: j -At LOZestlyt <br /> CONTRACTOR ADDRESS: STREET \at5P1 NE''l S. <br /> CITY F-. 5T1AA, STATE \r\j" ZIP C sE3,Q(31 <br /> CONTRACTOR PHONE: i-k- t4'16 - I1•cA-t-I,LI L CONTRACTOR EMAIL: {�LkA i-tLs-,gt--)g MU) i ,, cft«1 , <br /> CONTRACTOR LIC.#(REQUIRED): CITY OF EVERETT BUSINESS LIC.#(REQUIRED): <br /> PRIMARY CONTACT: 0 OWNER 0 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: <br /> CONTACT EMAIL: <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 1 am authorized by the owner of this property to perform the work for which application is made and 1 <br /> comply with the State Contractors Law 18.27 RCW and 296.200 WAC. <br /> City of Everett Official Use Only <br /> FEE <br /> 11 00 <br /> PERMIT# <br /> "ft. 4/ '...----1 / E n <br /> 0 (f) - \41) <br /> 4. •d 0- ‘ -0 , <br /> Owner/A thorized Agen Signature Date (Revised 10/1212015) <br />