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ELECTRICAL PERMIT APPLI ATION <br /> 4.-„, 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 I www.everettwa.gov/permits <br /> l*O�JECT SITE INFORMATION , <br /> M PROJECT ADDRESS: / f 41 I off---1- t i.,0 ()O(\ r� tifi gettpo 4 <br /> BUILDING AREA(if residential,new construction,remodel,or addition) <br /> SF 2S(.2(a V___c kS�L!1/l.. <br /> BUILDING TYPE: 0 SFR-DETACHED 0 SFR-ATTACHED 0 DUPLEX 0 MULTI-FAMILY-#OF UNITS: 0 COMMERCIAL <br /> USE OF BUILDING: J <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK: $ , q) q 9 LI <br /> '1 / <br /> NUMBER OF DEVICES(if low voltage): /�f •• c,0c t ok�CES. BOG* n_�J <br /> FIRE ALARM? 0 YES !AO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): jj. ` <br /> O PTION OF WORK: IVIS 4 •�-�w TA.--e, <br /> IV ?ot) l u Sty AWC19,u_P� <br /> 41.1J� , P tvc;jU >1 Gt topst C/, <br /> 1-P (/(tA'nOA <br /> CONTACT INFORMATION <br /> OWNER NAME: S C(cgs,ttk ke,(k TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET /0 314 I aimCc- i-L. (V e �J <br /> CITY �'_n-��--' STATE 1^T ZIP <br /> ^y r Le., OWNER EMAIL: TAZ S0' a.Ci ( OOL.C. h'N, <br /> OWNER PHONE: �p�' �� �/�� . <br /> CONTRACTOR NAME: Q.((Ife)TO h Cte(..t-e.1 e._ T t P <br /> CONTRACTOR ADDRESS: STREET 1316. .-.D(-10-t- - g 7 h. L. <br /> (I� CT <br /> RA,tzl I 6 tV h STATE tr)- ZIP 1 RA:' <br /> CONTRACTOR PHONE: ,/`(4 Cis- O675 CONTRACTOR EMAIL:,EMAIL:(AirtfIe btTht e(e6 (iv-sft' <br /> CITY OF EVERETT BUSINESS LIC.#(REQUIRED)a)LI 09 <br /> CONTRACTOR LIC.#(REQUIRED): �t2.k111.�t 22R C� (V ICITY <br /> PRIMARY CONTACT: ❑OWNER CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAM �-- r CONTACT PHONE: SW--i-- L(7 —0S76_ <br /> ctc I se 1( ( l.Z Du', CONTACT EMAIL: Lr(t ik `...0,-�� (Pc rei„c_&I ft . C014A. - <br /> ordinances governing <br /> wEEMENT:I ey that I have read ander examined thisanting of a permit does application and know he same to be ot presume to give authority to violate or cancel the proe correct. All provisions of laws visions of any other statehis ortype <br /> ofcwork will be completedg whetherospthe peed hereinnor not. The granting <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 /> PERMIT# <br /> ICNC\12-11=4"-A- - 6-6----1,e E tgo (p"( -( <br /> (Revised 9/23/2016) <br /> Owner/Aut rized Agen Signature Date <br /> \II <br />