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"IPA ---,‘ ELECTRICAL PERMIT ANLICATION <br /> wv <br /> vtif _ <br /> 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.gov www.everettwa.gov/permits <br /> PROJECT SITE INFORMATION': <br /> PROJECT ADDRESS: 1031, l'( 71-f AVL: Si , L`1v(>�6'7- 5eip-c ((7/( (06 <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: k'COMMERCIAL <br /> USE OF BUILDING: Al("Cr( (/S(,r c a>Al ptet24..tL <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK:$ 39Caa0 <br /> NUMBER OF DEVICES(if low voltage):• <br /> FIRE ALARM? 0 YES ONO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIPTION OF WORK: , (310/51.2/41-6 P k4/15-<, f TWO -'( & ,, <br /> eV IL_ ti /•1 , cr feu tTS 7'' ) -/ o /max IsT1a.i, 7-r._6rrS A- <br /> I-(a)1 T5 , <br /> CONTACT;INFORMATION" <br /> OWNER NAME: TENANT NAME(If Commercial): D i2, C(-I 1 f O 6Q o`.( <br /> OWNER MAILING ADDRESS: STREET <br /> CITY STATE ZIP <br /> OWNER PHONE: OWNER EMAIL: o f2 A R 214 0LA @ A 2 C 1•f 1 En Gotly ,c ,A-' <br /> CONTRACTOR NAME: ,\.. k S T^(3Ci-} <br /> CONTRACTOR ADDRESS: STREET 32..CI 2 L( t g /3(T1.{ ,c7- 1 /� <br /> CITY U(yvf.�-C C STATE r/"✓'I ZIP Neve, <br /> CONTRACTOR PHONE: y(-2-6-- Li 17- 7312 CONTRACTOR EMAIL: 3 s.4 I LOW. r3 q . 4 mA-!L 1 CO- <br /> CONTRACTOR LIC.#(REQUIRED): - 1.6 Tel L- Ss3 CT (3 S CITY OF EVERETT BUSINESS LIC.#(REQUIRED): <br /> PRIMARY CONTACT: ,IZI OWNER 0 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: -7 7_3''- 1117_ "73 oy a.� <br /> VI S T(,+.J t34/2L - CONTACT EMAIL: 3 (3A✓-�'moi✓'€ r3 4 '�1,l.A-le _6,O'vl <br /> AGREEMENT*T hereby certify that I have read and examined this application and know the same to be true and correct. All provisions of laws 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 tam 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 1827 RCW and 296.200 WAC. <br /> City of Everett Official Use Only <br /> FEE <br /> 4 \32, - <br /> PERMIT# <br /> _ �/' --/' -,IE( E 1310 --.' 10°1 <br /> -weer/Authorized .: Signature Date (Revised 10/12/2015) <br />