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li, <br /> �"--4 ELECTRICAL PERMIT APPLICATION <br /> CITY 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.everettwagov/permits <br /> _ <br /> t; t CO dttk INFORNFi#TfON <br /> PROJECT ADDRESS: 2 73 6. 12OGk„41'E /t., Cllr <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: 0 COMMERCIAL <br /> USE OF BUILDING: CNV/L.( <br /> CONTRACT PRICE OF WORK: $ ,2/000 <br /> NUMBER OF DEVICES (if low voltage): <br /> FIRE ALARM? 0 YES 0 NO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIPTION OF WORK: UPj,,A-CC # TOP FLooL sUi3-P4 uLC,l A--,o j,/ <br /> S '.I)vlr rV (if -J aau Mo ail f/IL <br /> .._ .. . . C01 #0.--= 0 O M ICN ._ 1 <br /> OWNER NAME: FliQ Pgfis.pyrrN AU c JM)NANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET�/> 12.ocitxFE L-LCA r, 1 <br /> S V ` - I � U��� STATE (BVI w!'-' ZIP ?/.20,/ <br /> OWNER PHONE: L/.L OWNER EMAIL: V� <br /> CONTRACTOR NAME: Sift_ `lU f S / £fJ ( /`/ <br /> CONTRACTOR ADDRESS: STREET �3^(p1)1 Fv L�kC f 6 A.� D <br /> CITY i 46 f STATE hi) ZIP ?fC,4J <br /> / <br /> CONTRACTOR PHONE: 7 1j )J 2/4 / CONTRACTOR EMAIL: UUU <br /> CONTRACTOR LIC.#(REQUIRED). hip,izl yup _ CITY OF EVERETT BUSINESS LIC.#(REQUIRED):0/6 3 <br /> PRIMARY CONTACT: 0 OWNER 0 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: (#11 ).3/ 7 <br /> IXT(A/ CONTACT EMAIL: J <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 I am authorized by the owner of this property to perform the work for which application is made and l <br /> comply with the State Contractors Law 18.27 RCW and 296.200 WAC. <br /> City of Everett Official Use Only <br /> Fff <br /> leilc 102. ,b°� <br /> PERMIT# <br /> 1 X/01-sq/4 E ti l' IA <br /> Owner/Authorized •ge Ig,-,ture Date (Revised 10/12/2015) <br />