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ELECTRICAL PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> (P)425-257-8810 FAX 425-257-8857 (E) everetteps@everettwa.gov j www.everettwa.gov/permits <br /> PROJECT SITE INFORMATION" <br /> PROJECT ADDRESS: 6 / (p t.a ET P-4 et,PJ t'i V <br /> BUILDING AREA(if residential, new construction, remodel,or addition) A 0 0 SF <br /> BUILDING TYPE: TS SFR-DETACHED 0 SFR-ATTACHED 0 DUPLEX 0 MULTI-FAMILY-#OF UNITS: 0 COMMERCIAL <br /> USE OF BUILDING: 5 F <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK: $ 4'5 64:t6 <br /> NUMBER OF DEVICES (if low voltage): <br /> FIRE ALARM? 0 YES Er NO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIPTION OF WORK: k_5U-5 c •c e--4 N <br /> CONTACT INFORMATION <br /> OWNER NAME: ‘TLtt.F RW13 11-S S O`er TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET S Mfi <br /> CITY STATE ZIP <br /> OWNER PHONE: 9 AS 9'.-3—`73 5-5- OWNER EMAIL: <br /> CONTRACTOR NAME: H c'C.,I 1-1T'( F.1 CTIA.(CJ a ((v <br /> CONTRACTOR ADDRESS: STREET 3e(''S" St �j c4.r" s <br /> CITY t "O4=FV.: _ STATE iitth• ZIP 9&2 c / <br /> CONTRACTOR PHONE: '1 - 3(e- OCo i3 CONTRACTOR EMAIL: frf c-L ef..3T C Wit.c�T+2tc C <br /> CONTRACTOR LIC.#(REQUIRED): c-V I`fJ SC o 0 3 IJ Zr- CITY OF EVERETT BUSINESS LIC.#(REQUIRED): 03 g34 O <br /> PRIMARY CONTACT: 0 OWNER CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: 04((cG A-t c t o CCONTACT PHONE: (1,,5 30 e-a ccp 3 <br /> CONTACT EMAIL: S(4/moi <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 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 /> 1. CC <br /> PERMIT# <br /> ��./'� - ®_ E �.0� - �( <br /> Owner/Authorize t Iggnnafure Date (Revised 10/9212095) <br />