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_�VIIIIIIII . <br /> 477 LECTRICAL 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.gay 1 www.everettwa.govlperrnits <br /> PROJECT SITE INFORMATION <br /> PROJECT ADDRESS: l C3Q 61-14 <br /> BUILDING AREA(if residential,new construction,remodel,or addition) SF <br /> BUILDING TYPE: 0 SFR-DETACHED0 SFR-ATTACHED- 0 DUPLEX 0 MULTI-FAMILY-#OF UNITS: f--COMMERCIAL <br /> USE OF BUILDING: (-I asp Ciet.f <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK:$ 4(500.0" <br /> NUMBER OF DEVICES(if low voltage): <br /> FIRE ALARM? CI YES 416410 <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIPTIO OF WORK: �wtovC. t2-0V. rpm Dlc 5kr: <br /> c _`i Iit 3.Ct r �Cv�� s�QQ cGO%r t VlS raw• rttSGpvi n c c+ It s-E-Cr I I I Lt. <br /> CONTACT IlNFORMATION <br /> OWNER NAME: Pmv ent 1 Sso: � titectr r TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: smiaerI�3C>( �.i J i; S `"`b({, <br /> CITY 2 +0� STATE 4)4 zip f <br /> OWNER PHONE: TOWNER EMAIL: <br /> CONTRACTOR NAME: VCC4 E #.t-c_ <br /> CONTRACTOR ADDRESS: srmteer :50Iq -3T" 4cl <br /> Cm Sea+44.e...- STATE i"),4 zm 8 to S <br /> CONTRACTOR PHONE: 2c- 3(0--5za), 'CONTRACTOR EMAIL: <br /> CONTRACTOR LIC.#(REQUIRED}: lttC' ge-Z.Sr./2„M\,� • <br /> . .. ... . .. . ..... .. .. .. Jerry OF EVERETT BUSINESS LIC.#(REQUIRED):00c(5'g j <br /> PRIMARY CONTACT: 0 OWNER O CONTRACTOR PkOTHER(Please Specify) .Fir Ic4 6 rw1 ,�,r c - <br /> CONTACT NAME: CONTACT PHONE: <br /> _14%0/v Se z(A a)4- -t) CONTACT EMAIL: <br /> AGREEMENT i herebySrvt T Sc t+trtw a`j t/ R <br /> of <br /> AGREEMENT: <br /> will T completed whether 1 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 /> p� 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'consfruction or the performance of construction. That i am authorized by the owner of this property to perform the Werk for which application is made and I. <br /> comply with the State Contractors Law 1817 RCW and 296.200 WAC. <br /> City of Everett Official Use Only <br /> PERMIT# <br /> DLvdwdC tI <br /> Own Authorized7ent Signature DaZte <br /> (Revised 8/23/2078) <br />