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#1 ► 4ECTRICAL PERMIT APOLICATIO►N <br /> Imo►' CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 ( (E)everetteps©everettwa.gov( www.everettwa.gov/permits <br /> PROJECT SIT 1 ATION <br /> PROJECT ADDRESS: I I 1:4kvr,olci.4 ,c, C <br /> BUILDING AREA(if residential,new construction,remeQel,or addition) SF <br /> BUILDING TYPE: 0 SFR-DETACHED 0 SFR-ATTACHED 0 DUPLEX 0 MULTI-FAMILY-#OF UNITS: 0 COMMERCIAL <br /> USE OF BUILDING: <br /> ELECTRICAL AP .LICATIIcN INFORMATION <br /> CONTRACT PRICE OF WORK: $ 2,00 <br /> NUMBER OF DEVICES(if low voltage): <br /> FIRE ALARM? 0 YES 0 NO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): . <br /> DESCRIPTION OF WORK: J, IJ ilia.ylop, 1--,P41045 kVA 1 .f , <br /> ORMAt10I <br /> -,.-:,,,4-.4::,.-,:;,-,i-- ,-..... CONTACT"'I F.. . ... <br /> OWNER NAME: TENANT NAME(If Commercial): Co( yr„ (i/. -act, <br /> OWNER MAILING ADDRESS: STREET <br /> CITY STATE ZIP <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: - _ <br /> 5f ..9-17SSS <br /> CONTRACTOR ADDRESS: STREET /�f X06 141,07 Cj q A <br /> CITY / LJe,il STATE v/�- ZIP ikL' <br /> CONTRACTOR PHONE: 424---)-7?_r 2,. CONTRACTOR EMAIL: i '"ck - _ C'_r <br /> CONTRACTOR LIC.#(REQUIRED) ' y3 CI �,, F EVERETT BU INE3 LIC,. � ' �/#(REQUIRED: .? <br /> r.. � as <br /> PRIMARY CONTACT: 0 OWNER \NTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: <br /> 34vvit,....., ✓' K CONTACT EMAIL: /mss (a. <br /> >°� <br /> � Ufi �- � row. <br /> AGREEMENT.:I hereby certify that!hive read and examined this application and know the sambe true and correct.Alprovisi s of laws a dTf ordinances governing this type <br /> 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 /> ( 5 _„...o-> PERMIT# <br /> /0 .--4.) �1 <br /> E15/0- 077 <br /> Owner/Authorized Agent Signature Date (Revised 9/23/2016) <br />