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ELECTRICAL PERMIT APPLICATION <br /> /11°141404r7----4 <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:n2O (�J- jYei A\((:;:: =_. . <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:C,D(Nir(1Px'CQ(t X <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK: $ SOO, <br /> NUMBER OF DEVICES (if low voltage): <br /> FIRE ALARM? 0 YES It.NO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): p "c <br /> DESCRIPTION OF WORK: Vt\ Ctk,�O k\D(1 DY (k) 7r1JJ d� <br /> CONTACT INFORMATION <br /> OWNER NAME:32.2.0 PA`(\C),(ei LL� TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET 32 �f�- 1(�(�'�+( , *fp <br /> CsIT?Y )1(yPXt44' STATE\N� A zIP`� < 2 O <br /> OWNER PHONE: � OWNER EMAIL:�*hU`‘ l��-7ZVIOI <br /> CONTRACTOR NAME:kukel YUt C X\ dca( -) <br /> I <br /> CONTRACTOR ADDRESS: STREET 11,14'--6 e. <br /> CITY 6 f STATE "!A ZIP Q,g j 24 <br /> - <br /> CONTRACTOR PHONE:(C(Q)( CONTRACTOR EMAIL: ,Wp\C 11CaApit e3UC7l1(cIOfPCIAYt •1n� <br /> ax <br /> 1g5 LIC.#(REQUIRED): � 1g5 CITY OF EVERETT UBUSINESS✓LIC.#(REQUIRED):0C) <br /> PRIMARY CONTACT: 0 OWNER ELCONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME`:-C� 41* c_68-CONTACT PHONE: 4 , <br /> � p�� <br /> t�COicpcq V- V CONTACT EMAIL: ' do �' ,kcAv\l7y\-c3uACXYc&tC�.y`Lrl..,If 4 CQhl <br /> AGREEMENT:I hereby certify that I have read and examined this application and know the same to be true a d co,'r€ t. 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 /> PERMIT# <br /> • e.ef��� r E "x(;06—I-71 <br /> Owner/Authorize;Agent Si nature Date (Revised 9/23/2016) <br />