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/"P' ELECTRICAL 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 I (E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> PROJECT SITE INFORMATION' <br /> PROJECT ADDRESS l� m t 19' I�"'c \ S E CJ11--SliiSL3J <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: COMMERCIAL <br /> USE OF BUILDING: 1 al (a o-' <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK:$ 7 S 0 O <br /> NUMBER OF DEVICES(if low voltage):• <br /> FIRE ALARM? ❑YES A NO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIPTION OF WORK: ((�� <br /> (29.0.. I L---&K..mrt . o..,v-, C'1`A-/a1 <br /> CONTACT;INFORMATION <br /> OWNER NAME: v-N TENANT NAME(If Commercial): ItF.ki7,.r_ <br /> OWNER MAILING ADDRESS: STREET <br /> CRY STATE ZIP <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: S v\(1E_ LL -- <br /> CONTRACTOR ADDRESS: STREET 1C \e4( ""- 'uJ-_{ C <br /> � �/JestCITY J lV STATE G 1l�j <br /> ZIP <br /> CONTRACTOR PHONE: -2..,c3 j 7 1 1.2_ CONTRACTOR EMAIL: <br /> CONTRACTOR LIC.#(REQUIRED)6 mes 0s,L G 3 1 l<Z CITY OF EVERETT BUSINESS LIC.#(REQUIRED)Ct S CC I E <br /> PRIMARY CONTACT: 0 OWNER E'CONTRACTOR 0 OTHER(Please Specify) <br /> CON CT NAME: lc, , 3 CONTACT PHONE: 3 r`f c.-169.k <br /> W CONTACT EMAIL: <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 I 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 /> PERMIT# r <br /> A19"..'*iih. ( <br /> Owner/Authori ed Agent Signature Date (Revised 90/92/2095) <br />