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0427 ELECTRICAL 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 j (E)everetteps@everettwa.gov j www.everettwa.gov/permits <br /> 2 PROJECT SITE INFORMATION <br /> PROJECT ADDRESS: e-t+�-OO t3 9+ EvLam* h'4 "Bet) <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: ,OMMERCIAL <br /> USE OF BUILDING: <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK:$ tOOO."c" <br /> NUMBER OF DEVICES(if low voltage): <br /> FIRE ALARM? 0 YES IKNO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIPTION OF W RK: S k, re-etc cry •)ec P4-erer se.rG.�r' <br /> /Cue..( �7 04-a. bre..GLL roo ms <br /> Le VL( I)Z '- r lc.— r-0ca <br /> CONTACT INFORMATION <br /> OWNER NAME: r 1 IL •0.1.4. picji CG.( TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET (b6\ £.-(4 E SO 41 1'©((p <br /> .. .. CrrY p k \ STATE a-)A ZIP' 61005- <br /> OWNER <br /> 190`SOWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: V r C4 t:�eC�s`cC <br /> CONTRACTOR ADDRESS: sTREEr C(2 <br /> 1� 1 <br /> AJ S p <br /> CR Sl/'.1.�t'4�- STATE 1 4 zu, TMJ l o g <br /> CONTRACTOR PHONE: ZO(a- '1 3(o - 5`2_00 CONTRACTOR EMAIL: <br /> CONTRACTOR LIC.#(REQUIRED) VES -3. S-42-M. CITY OF EVERETT BUSINESS LIC.#(REQUIRED):()Oe?q j^. <br /> PRIMARY CONTACT: ❑OWNER 0 CONTRACTOR %OTHER(Please Specify) 'Re.lc £C 4Cra.[ -For-c 044 <br /> CONTACT NAME: ( CONTACT PHONE: 2 p(, 175-0 Z 7 U <br /> c��SD/X ��oc LJ�i I c\ CONTACT EMAIL: �,c A/ SGDuziu,o't /i C-4.Cori' <br /> AGREEMENT:I hereby certify that I have read and examined this application and know the same to be true and correct. All provisiors 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 <br /> comply with the State Contractors Law 18.27 RCW and 296.200 WAC. <br /> City of Everett Official Use Only <br /> PERMIT# <br /> /' ,�� 11/°/6 EVT3o ^b(Q2_ <br /> 0 /Authorized Agent Si• ature Date (Revised 9/23/2016) <br />