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ELECTRICAL PERMIT APPLICATION <br /> 0410"4/.7.1 ,-,- CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> (P)425-257-8810 1 FAX 425-257-8857 1 (E)everetteps@everettwa.gov1 www.everettwa.gov/permits <br /> 661. PROJECT SITE INFORMATION'. <br /> PROJECT ADDRESS: 4-' OCe 14/1/4) A-ve <br /> BUILDING AREA(if residential,new construction,remodel, or addition) 900 0 SF • <br /> BUILDING TYPE: 0 SFR-DETACHED ' SFR-ATTACHED ❑DUPLEX 0 MULTI-FAMILY-#OF UNITS: 0 COMMERCIAL <br /> USE OF BUILDING: <br /> ELECTRICAL APPLICATION INFORMATION • <br /> CONTRACT PRICE OF WORK:$ 12,j JOO . by • <br /> NUMBER OF DEVICES(if low voltage):• <br /> FIRE ALARM? 0 YES 0 NO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): p� <br /> DESCRIPTION OF WORK: CI IIIA- AMA/ 2.000 SQ -f'/ cFit- <br /> • <br /> CONTACT;INFORMATION <br /> OWNER NAME: Vf,5- ,{, ems 1 1W Ca-K51,eadt1).TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET PC) C o 1 a. Y3 <br /> CRY ! afy, <br /> Vi lto. f STATE W 7 ZIP 95)7VOWNER PHONE: T 2,5- 8.4 !(i, �^O�c,d'WNER EMAIL: y ptS4A.ydCtil L 1ftt eii Com?y 44.er'` . Om1 <br /> Lit IQ- <br /> CONTRACTOR NAME: of 7✓ lc- LLC <br /> CONTRACTOR ADDRESS: STREET (L( q,'-‘. dq-V i ALE <br /> CITY l 444. j <br /> "J STATE JAo) ZIP Fe,2 <br /> CONTRACTOR PHONE: 112,c 3 2,1 'Z(4 L( CONTRACTOR EMAIL: 14 k S+ C S C Z r' r 441c r 7, met <br /> CONTRACTOR LIC.#(REQUIRED): L-1-£.5Sf$40C 3 CITY OF EVERETT BUSINESS LIC.#(REQUIRED):33- D <br /> PRIMARY CONTACT: ❑OWNER yCONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: 1/ 'Z 327 71(1(7/ <br /> U ( CONTACT EMAIL: it rk $ V 4S e f Q.clvi (�.7 (44rl.Crepi <br /> AGREEMENT.-T hereby certify that I have read and examined this application and know the same to be true and correct. All provisions oflaws 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 t 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 /> FEE <br /> . 0 MS <br /> J1/ <br /> PERMIT# <br /> g-td-11 1sblot- h (:. <br /> Owner/Authorized Agent Signature Date (Revised 90/92/2095) <br />