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ECTRICAL PERMIT AP•CATION <br /> /1111P*/***.sC---1CITY 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 SITE INFORMATION <br /> PROJECT ADDRESS: (05 7)i ��i;,1 I`P„r DR,. c 1.t /-e 4 <br /> BUILDING AREA(if residential,new construction,remodel,or addition) SF <br /> BUILDING TYPE: 0 SFR-DETACHED 0 SFR-ATTACHED 0 DUPLEX 0 MULTI-FAMILY-#OF UNITS: .COMMERCIAL <br /> USE OF BUILDING: T�y4 ItD I�6= Yw+C /LI TY <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK:$ moi' a©7 <br /> NUMBER OF DEVICES(if low voltage): <br /> FIRE ALARM? ❑YES 11 NO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIPTION OF WORK: f u ,Vf £X l"" Sigh <br /> CONTACT INFORMATION <br /> OWNER NAME: TENANT NAME(If Commercial): /M P&r ?Asaafl/fn 641( <br /> OWNER MAILING ADDRESS: STREET <br /> CITY STATE ZIP <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: L)9-t/ c7- --u�n 2Sc.e.riz I L az. <br /> CONTRACTORADDRESS: STREET / Gtr J//3$/S' 2 34i- S•>NE 44 6 p�j <br /> CITY Le 'w "c� STATE fi✓IQ' ZIP I(7 p <br /> CONTRACTOR PHONE: LIZ(" 32.7 7 Z/l/7 CONTRACTOR EMAIL: /c(/,,e,ckvcH.1 e,`e&Irt ?yAit,r4it.,Cows <br /> CONTRACTOR LIC.#(REQUIRED):G ES,SE S OC 3 CITY OF EVERETT BUSINESS LIC.#(REQUIRED): cS`f 90 <br /> PRIMARY CONTACT: 0 OWNER $CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: 1/Z..( 32 —2 74" „, • <br /> J i/Z ek roz,/r CONTACT EMAIL: /4frlem,..�r,it�./ I9t�a.%• <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 lam 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 ,,��,,�� <br /> D <br /> PERMIT# <br /> -gig7 E-k) t-7ot -003 <br /> Owner/Authorize,Agent Signature Date (Revised 10/12/2015) <br /> OV- IPS41 r t- `e. (sr``t <br />