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477 PJLECTRICAL PERMIT AO'I ..ICATION <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 www.everettwa.gov/permits <br /> PROSIIN <br /> JECT TE FRMATI <br /> OON <br /> .�. . ., _..,.. tea . . .. .. � td ., _ . <br /> PROJECT ADDRESS: 4b Z1 44`' "sem SE <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: Igt COMMERCIAL <br /> USE OF BUILDING: LJ4..S-}Q,c,1a.,l<Z,f' '(creak Q,r*" t.a.".+- <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK:$ 12 S, CC'O <br /> NUMBER OF DEVICES (if low voltage): <br /> FIRE ALARM? 0 YES ($NO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIPTION OF WORK: 2,04 $10".bA- Pkain4t.0,"c-2,_ e-f`wvr -- W t,,st <br /> CONTACT INFORMATION <br /> OWNER NAME: Ci-4 t1 0* 5..AVhre TENANT NAME(If Commercial): w PGF- <br /> OWNER <br /> GFOWNER MAILING ADDRESS: STREET 3 of 2 t,.) o-n- �Q-- <br /> cm, 60STATE l.A.,fl ZIP 9$W ' <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: W IBJ <br /> CONTRACTOR ADDRESS: STREET <br /> CITY STATE ZIP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> CONTRACTOR LIC.#(REQUIRED): CITY OF EVERETT BUSINESS LIC.#(REQUIRED): <br /> PRIMARY CONTACT: 0 OWNER 0 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: 1-[2.5% 24 7 8 t_..3 ZCONTACT EMAIL: n c .fi:5;6 e..., E.ut. t.'Q ,3 QV <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 l 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 /> (:61CA <br /> (—/0-it/ ri 01'• <br /> Owner/Authorized Age t Signature Q Date (Revised 9/23/2016) <br /> I tD Ot)" <br />