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eir,._ _ <br /> -ELECTRICAL PERMIT A UICATION <br /> NIIII ,- 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: (Orr) U )55 a C- 1 G,k e. d, 11 \ 1) F v es Q-A-k- W lc <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: lit COMMERCIAL <br /> USEOF BUILDING: E i S rii i_YI [' <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK:$ (,, 1 000 <br /> NUMBER OF DEVICES(if low voltage): <br /> FIRE ALARM? 0 YES 0 NO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): . <br /> DESCRIPTION OF WORK: Ty,e)-(-a f 1 ;Ir\ 100 \j v-0 CSS aCce,s f 0`v\-\,S <br /> • <br /> CONTACT INFORMATION <br /> OWNER NAME: D5 F 9 DSI,ev(e,.('r -'z- 1 h-c TENANT NAME(If Commercial): 05E4 D t;\jety CckLY- <br /> OWNER MAILING ADDRESS: STREET two I I( ,alAk55c0c.,‘6,el, 61 V D <br /> CITY .„., t c`-liki 4^ STATE \Ai\-iA ZIP 78 <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: 4 0 ..e s % F I Pic--6-i . ' ` , . <br /> CONTRACTOR ADDRESS: STREET 0 O 141i°v .f'C-E.3{/� 1 01r 5 t/�� 'C f- dOO- �+ <br /> CITY Ph cA , �C STATE Q I` Gl <br /> ZIP 300 0 . <br /> j <br /> CONTRACTOR PHONE: 770 ----7-7a_ 3�q j ONTRACTOR EMAIL:AX013s e,,.a L RoRt-g e•Ie -AA-,(.., i cow) <br /> CONTRACTOR LIC,#(REQUIRED):F Cl. r- ' K`7 j 5 CITY OF EVERETT BUSINESS L C #(REQUIRED),fj 1'3[04 <br /> PRIMARY CONTACT: ❑OWNER ( CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: 11.70 V2 5 - OQ 5 <br /> -/`c1nnV\ 44os&y- CONTACT EMAIL:AXnas"r 0 Lka,01 <br /> pr�2.ICcAv1c . GOV1 <br /> AGREEMENT:T hereby certify that I have read and examined this application and know the same to be true and correct. All pro isions 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 lam 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 /> ' _ ©o <br /> PERMIT# <br /> Owner/Authorized Agent $ <br /> e Date (Revised 10/12/2015) <br />