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OLECTRICAL PERMIT AFI LICATION <br /> „.4141 _ 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:tO0c 1 c 44 Atm- 56 <br /> BUILDING AREA(if residential,new construction, remodel, or addition) 'CTO SF • <br /> BUILDING TYPE: 0 SFR-DETACHED 0 SFR-ATTACHED 0 DUPLEX 0 MULTI-FAMILY-#OF UNITS: ,COMMERCIAL <br /> USE OF BUILDING: r.e <br /> AL <br /> R <br /> ELECTIC ..., <br /> _ .. .._ . :,... : -.. ., � ...:: APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK:$ 5-76- a> • <br /> NUMBER OF DEVICES(if low voltage):, S,5 <br /> FIRE ALARM? 0 YES -VINO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIPTION OF WORK: ,o iw.. rn..n1 ,- <br /> CONTACT INFORMATION. <br /> OWNER NAME: TENANT NAME(If Commercial): Ce1,11 t J 42/ <br /> OWNER MAILING ADDRESS: STREET <br /> CITY STATE ZIP <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: �j, )ft- L e <br /> CONTRACTOR ADDRESS: sTREET !" <br /> ( W Wka.no ,� <br /> ,. , <br /> CITY e. yr 0 —. --S- STATE f/ ZIP 1 71 <br /> J <br /> CONTRACTOR PHONE:3K(3 '7 //u <br /> . CONTRACTOR EMAIL:'.),,.s4/4,,e• 4cp 'dC i'G . (poi <br /> CONTRACTOR LIC.#(REQUIRED) (.J/-crt5r er Cj i L CITY OF EVERETT BUSINESS LIC.#(REQUIRED):4'9-73/4 <br /> PRIMARY CONTACT: 0 OWNER RCONTRACTOR 0 OTHER(Please Specify) <br /> CON ACT NAME: CONTACT PHONE: 3K-c) Ts- 7 /` . . <br /> es 1 CONTACT EMAIL: ¢ 1 . / � <br /> �. r>—T�i 'i j�� (6:19,-)AGREEMENT T hereby ce that I have read and examined this application and know the same to be true and ect. 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 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 <br /> FEE <br /> PERMIT#Q T <br /> `4 - Oki ‘ <br /> n• •uthor¢-. -.- • ature Wr <br /> (Revised 10/12/2015) <br />