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IgLECTRICAL PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> (P)425-257-8810 1 FAX 425-267-8857 1 (E) everetteps@everettwa.gov www.everettwa.gov/permits <br /> PROJECT SITE I1h\GOO RIMATIIOr <br /> PROJECT ADDRESS: e&/ 3 )(A U I CEL W 1/4! <br /> 'BUILDING AREA(if residential,new construction,remodel,or addition) 800 SF <br /> 'BUILDING TYPE: KSFR-DETACHED 0 SFR-ATTACHED 0 DUPLEX 0 MULTI-FAMILY-#OF UNITS: 0 COMMERCIAL <br /> USE OF BUILDING: <br /> ELECT-, APPLICATION INFO ELATION <br /> !(CONTRACT PRICE OF WORK:$ (p 00 <br /> NUMBER OF DEVICES(if low voltage): <br /> FIRE ALARM? 0 YES 1:J NO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): G I Q D l-.()OS <br /> Y DESCRIPTION OF WORK: '' f O'J e. SI-10 .1 C 22-0 v (Vo7i 9 / <br /> •vp s:fSLL K\reikE J S 0,-N5 I '2 e-Lcc . rpt, ca-RG-15 <br /> CONTACT IINFO•GI,EIAT)!®Pe9. <br /> %( OWNER NAME: C- AG W (..,cif TENANT NAME(If Commercial): <br /> Ce, v 2 LtiA <br /> OWNER MAILING ADDRESS: sTREEr e(0 1`(y .�� 0� -e l� '{ s ���c <br /> CITY 61 L�� V STATE (J ` ZIP q , <br /> OWNER PHONE: OWNER EMAIL: <br /> X CONTRACTOR NAME: 0.\,N' i\) C-a__ <br /> CONTRACTOR ADDRESS: STREET <br /> CITY STATE ZIP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> CONTRACTOR LIC.#(REQUIRED): CITY OF EVERETT BUSINESS LIC.#(REQUIRED): <br /> PRIMARY CONTACT: 0 OWNER 0 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: <br /> CONTACT EMAIL: <br /> AGREEMENT:T hereby certify that/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 /> CD <br /> IO0I <br /> [-----------PERMIT# <br /> y 6 g 5_/, / , <br /> z,,,, , E \(e() .- 1L-\ <br /> Owner/Authorized Agent Signature Date (Revised 10/12/2015) <br />