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ELECTRICAL PERMIT APPLICATION <br /> #1.111../4.41•4/4:":1 <br /> I it 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 I www.everettwa.gov/permits <br /> PROJECT SITE INFORMATION <br /> PROJECT ADDRESS: -r)D (3TtA F Lre re:R I t/3 gSZO 1 <br /> BUILDING AREA(if residential,new construction,remodel,or addition) SF <br /> BUILDING TYPE: 0 SFR-DETACHED D SFR-ATTACHED- 0 DUPLEX 0 MULTI-FAMILY-#OF UNITS: 7COMMERCIAL <br /> USE OF BUILDING: d1n-k- 1 // <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK:$ 2213O0. <br /> NUMBER OF DEVICES(if low voltage): <br /> FIRE ALARM? 0 YES NO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIPTION OF WORK: 12pUe_ FitihoL.S atict rr.j Gc-C_ tA-7? 14 b.--ler y <br /> c-(- 2, 1 Oc�.�ti� ip L c Q2 C 4 ,uric <br /> PCONTACT INFORMATION <br /> OWNER NAME: Prov-,`cttr c C g.eS t\a h G ( /lAtekt`cc, TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET (Ar_m L i tin 4- r S 4 1616 coil- <br /> cm/ <br /> tZervi-e,� co-- STATE' 1. ZIP O 05- <br /> OWNER <br /> 5OWNER PHONE: OWNER Eli- <br /> CONTRACTOR NAME: VSA E-t dr / <br /> CONTRACTOR ADDRESS: sTREET 5R I� 1 ire:. j�`,q <br /> CITY Siat+I L STATE IAA ZIP 449/CJS <br /> CONTRACTOR PHONE: 2o& 43 " SZUD CONTRACTOR EMAIL: <br /> CONTRACTOR LIC.#(REQUIRED): Val(E G.'52,14 U CITY OF EVERETT BUSINESS UC.#(REQUIRED):Ob ill 1 s'- <br /> PRIMARY CONTACT: D OWNER 0 CONTRACTOR OTHER(Please Specify) FiL.1�-tJ <br /> 6e-i lc.a-e ( Fo✓epinet i <br /> CONTACT NAME: CONTACT <br /> �1 CONTACT PHONE: 2.04,_95-0 -49-3g <br /> �ySOiy SCID I`31JA LD CONTACT EMAIL: 0 4. Sc �a Lc( , MCA, C-O"fl <br /> AGREEMENT:I hereby certify that t 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 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 4PERMIT# <br /> +.�ve�r . zz , EIT# fl <br /> O •= Authorized .,tent Signature Date (Revised 9/23/2018) <br /> \112 D <br />