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ei...._ ELECTRICAL PERMIT APPLICATION mow/ -- CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET, EVERETT,WA 98201 (P)425-257-8810 I FAX 425-257-8857 I (E) everetteps@everettwa.gov I www.everettwa.govlpermits PROJECT SITE INFORMATION PROJECT ADDRESS: it)Q 5 Q I N E(-KA‘ ''% Aci& Ft/E-g6 tT ( K2_63 U MT (j BUILDING AREA(if residential,new construction,remodel,or addition) .7_700 SF BUILDING TYPE: 0 SFR-DETACHED 0 SFR-ATTACHED Nc UPLEX 0 MULTI-FAMILY-#OF UNITS: 0 COMMERCIAL USE OF BUILDING: ► GSl = (,----- ELECTRICAL - -ELECTRICAL APPLICATION INFORMATION CONTRACT PRICE OF WORK:$ ccS—S-J NUMBER OF DEVICES(if low voltage):, w/%}- FIRE ALARM? 0 YES 451C0 ASSOCIATED BUILDING PERMIT#(if applicable): DESCRIPTION OF WORK: to p&FA-Dt 6)((S1 U-6-- 40O Auk,/ p seKU.t CL, \) t 1 Vi- / T1-'O /AL I=77=rte (5/4-S(= - W 6A-7-Cfih+e_ 1+t 40 FOK - . U. fa1 T / 2 Li AII'T 4-& 7 IV i ) g&w 1 r2`M- uP --gsq-DLA 1 4 Ai I'T A 67-15- St)Mc l-niUt u iuf feL Lt Ri -Cv CONTACT INFORMATION OWNER NAME: Fx Es ki. Lcze d-FO bTENANT NAME(If Commercial): OWNER MAILING ADDRESS: STREET r 606 Z A-U "0 g.11- AVEN It 36 34/ f 2 CrrY 56-:=-4- / / f sTATE of-A—. ZIP `�ic1/3 3 OWNER PHONE: 206... 72-1,. .,3 4 2 OWNER EMAIL: QU1 v I Vv 1,e5 V'1 4,VG�.K,', ,' C-, CONTRACTOR NAME: ellg..cJY r S G LF.Te-(C.. CONTRACTOR ADDRESS: STREET 27,0 zst]' i` 1,.._" 1 (eep 7."- i CITY 1-ik� I (ft- STATE W• , '. ZIP Ci X/4 V/� s CONTRACTOR PHONE: 2.53 --2 4 _a--76-i_CONTRACTOR EMAIL: CONTRACTOR LIC,#(REQUIRED): -1-�� 50''I°r 7j a� CITY OF EVERETT BUSINESS LIC.#(REQUIRED): S 7 S PRIMARY CONTACT: ❑OWNER CONTRACTOR ❑OTHER(Please Specify) CONTACT NAME: i► A CONTACT PHONE: 2.O Z. - -01 01 /_ ' °�u�my ij vk,�i(V' CONTACT EMAIL: -lbw Tom c,/ I(e&0,IJ 6,11. -I L----- 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 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 local law regulating construct/on or the performance of construction. That l am authorized by the owner of this property to perform the work for which application is made and I comply with the State Contractors Law 18.27 RCW and 296.200 WAC. City of Everett Official Use Only FEE PERMIT# ICTOM n� ,t f 0Sl WIDti Owner/Arized Agent S gnature Date (Revised 10/12/2015)