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ELECTRICAL PERMIT APPLICATION <br /> #°41;----A <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.everettwa.gov/permits <br /> PROJECT SITE INFORMATION <br /> PROJECT ADDRESS: 7// c /c e, 41,c <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: c 5 /o/c j c, / <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK:$ 2 G vv <br /> NUMBER OF DEVICES(if low voltage): <br /> FIRE ALARM? 0 YES ANO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIPTION OF WORK: s /< // ,o a c,, /7/V,A9 C Sia/," v •o �=f <br /> G✓Icr /'�✓c,oale / e Ti-95 6 .•77 <br /> CONTACT INFORMATION <br /> OWNER NAME: C r' / 'id J'i ,- .CJeeso TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET /< <br /> L 7 // /-{�v c <br /> CITY L,/ r' /�c // STATE " ZIP Y r Al <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: /9v r h /> - 6/eo . c <br /> CONTRACTOR ADDRESS: STREET / 3 O / S <br /> CITY /J v t+/ STATE k/4 ZIP 9'8 2 3-2 <br /> CONTRACTOR PHONE: ' O 757 /300 CONTRACTOR EMAIL: /0 o Z, /)0 f,e/'e - G O/'"i <br /> CONTRACTOR LIC.#(REQUIRED): 0 7i"2 7Le1 /51 c /e CITY OF EVERETT BUSINESS LIC.#(REQUIRED): O__51-3 5,78_42 <br /> PRIMARY CONTACT: 0 OWNER 0 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTA NAME: CONTACT PHONE: 4/2 5 5 7/ <br /> / <br /> 5/17;914 CONTACT EMAIL: �L <br /> �osr�v �i5 / c� y �,c ./ec� <br /> AGREEMENT.'I 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 <br /> 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 I <br /> comply with the State Contractors Law 18.27 RCW and 296.200 WAC. <br /> City of Everett Official Use Only <br /> //d — PERMIT# <br /> E ( Ki <br /> Owner/Authorized Agent Signature Date (Revised 9/23/2016) <br />