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'' !LECA ICAL PERMIT APPLICATION <br /> Nway - 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: r',,*---(7 7y ( ,IL,E „S- g (-,J q., ' at 7.:17 Z23 <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: KCOMMERCIAL <br /> USE OF BUILDING: 5- 1-1(2).(7 <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK:$ ( I;j 3 s- 00 <br /> NUMBER OF DEVICES(if low voltage):, l" <br /> FIRE ALARM? 0 YES ONO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIPTION OF WORK: ?L-' - E . .,Z r l*-'1 &,(1-/N.- 1.5 1 f�(2 <br /> CONTACT INFORMATION <br /> OWNER NAME: 51' (Z'/ V/ciQ'(PA-CE6) TENANT NAME(If Commercial): EZ461-tOK j 4 i-rc C <br /> OWNER MAILING ADDRESS: STREET j 1;1? ' }-( ki f� 'S E.-- <br /> errs( g"-4.1 g://Z, �r7- STATE ,A ZIP 9.gz <br /> OWNER PHONE: Li g4 •2 5'3.1 t2• ( 1 ,. OWNER EMAIL: <br /> CONTRACTOR NAME: M l Cz-- (_.�,cr!Z.l <br /> CONTRACTORCT� ADDRESS:� STREET ( `i. 9 Z Z ( 7. 1, 4--, p�0 '� _-cj r <br /> S()l r (G '�* ( CITY fj 6� STATE l 5.5,As ZIP n74) z <br /> CONTRACTOR PHONE: ..zQ 4,50 6'57? CONTRACTOR EMAIL: • <br /> CONTRACTOR LIC.#(REQUIRED): I 1 1 _`,,,cc , , e,) CITY OF EVERETT BUSINESS LIC.#(REQUIRED):133170,& <br /> PRIMARY CONTACT:��❑OWNER CONTRACTOR ❑OTHER(Please Specify) . <br /> CONTACT NAME: CONTACT PHONE: go b S>to. .4.5), <br /> -44 ,t /i rtir� L CONTACT EMAIL: <br /> AGREEMENT:thereby c�ertify 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 lam 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 /> 60 a5s <br /> ` PERMIT# <br /> 7-‘'-- /? E 1 -"/40 'ci - 047L <br /> Owner/Auth//44 /P <br /> eA iii <br /> "ignature Date (Revised 10/12/2015) <br />