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'"fir.. a - o z-o) <br /> #11/P^/--,4 ELECTRICAL PERMIT APPLICATION <br /> I�►� CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 1 (E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> PROJECT SITE INFORMATION <br /> PROJECT ADDRESS: wC. ♦ IC?Ei,-F' ZL "� I�11 <br /> BUILDING AREA(if residential,new construction,remodel,or addition) LI(.9SF <br /> BUILDING TYPE: 0 SFR-DETACHED 0 SFR-ATTACHED 0 DUPLEX 0 MULTI-FAMILY-#OF UNITS: COMMERCIAL <br /> USE OF BUILDING: 7 Q (� � �� / <br /> ELECTRICAL APPLICATION INFORMATION <br /> CnNTRA(T PRICF OF WORK. $ / <br /> ( JO <br /> NUMBER OF DEVICES if low voltage): <br /> FIRE ALARM? 0 YES zt NO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIPTION OF WORK: CD+."^-P16*E--- e-CAWU2 k ijj-C <br /> Fi I - ,s / <br /> (( CONTACT INFORMATION <br /> OWNER NAME: g/1/4-041,V1/4, TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET 3 ) 1206,E fLLL. Q /V a l <br /> CITY GV t>"'o I 1. <br /> 1 STATE .s. 4 ZIP -`f. <br /> OWNER PHONE: OWNER EMAIL: tk 4/31, i2CtiLLLX�(LDTCd'J�G�C��G�-(z <br /> CONTRACTOR NAME: Milne Electric Inc. <br /> CONTRACTOR ADDRESS: STREET 14582 172nd DR SE <br /> cm' Monroe STATE WA ZIP 98272 <br /> CONTRACTOR PHONE: 360-863-9617 EXT#228 CONTRACTOR EMAIL: Duane.Leamer@Milneelectric.com <br /> CONTRACTOR LIC.#(REQUIRED): MILNEEI101 PN CITY OF EVERETT BUSINESS LIC.#(REQUIRED): 031702 <br /> PRIMARY CONTACT: 0 OWNER 0 CONTRACTOR El OTHER(Please Specify) SERVICE MANAGER <br /> • <br /> CONTACT NAME: CONTACT PHONE: 206-595-9243 <br /> DUANE LEAMER CONTACT EMAIL: DUANE.LEAMER@MILNEELECTRIC.COM <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 /> 2-( Z -5v <br /> PERMIT# <br /> E ( SDR <br /> Owner/Authorized Agent Signature Date (Revised 10/12/2015) <br />