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LLECTRICAL 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 1 (E)everetteps@everettwa.gov 1 www.everettwa.gov/permits <br /> PROJECT SITE INFORMATION' <br /> PROJECT ADDRESS: i I '-1-n-Y / '•i-. <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: �'! aCE <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK:$ J c , <br /> NUMBER OF DEVICES(if low voltage): <br /> FIRE ALARM? 0 YES j.kNO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIPTION OF WORK: ® .`" -j C RD, VI Sn i'Ni -- ANQ-€(—& <br /> CONTACT,INFORMATION <br /> OWNER NAME: ,V t- i...._.c_____... TENANT NAME(If Commercial): V 1 s-,,,A,ANv5 <br /> OWNER MAILING ADDRESS: STREET t 1 1../�'Tyfl:3 P V <br /> CRY CZ. STATE (.„r)�.j ZIP ZCA 1 <br /> OWNER PHONE: 3 — 3C,+—.53515 OWNER EMAIL: <br /> CONTRACTOR NAME: Ve.,Q j 4 l, .�crR 1 C 0._1:::::) 'L_C-7_e <br /> CONTRACTOR ADDRESS: STREET f C)_ x 9 (-) <br /> CITY e\I€ 1 STATE w it4 ZIP <br /> CONTRACTOR PHONE: 42S--,43,--)-23 i j CONTRACTOR EMAIL: ' <br /> CONTRACTOR LIC.#(REQUIRED): �CASSe� CITY OF EVERETT BUSINESS LIC. ) 65— <br /> #(REQUIREDI <br /> PRIMARY CONTACT: ❑OWNER NtSONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: 425 _ '''35—z j <br /> )L„-KIzAsset,1 CONTACT EMAIL: <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 /> 72 <br /> PERMIT# <br /> len22_511.0 E ( 3 (0- 12-7 <br /> Owner/Authorized Agent Signature Date (Revised 90/9212095) <br />