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4677 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: I G2s. fJl/kI2 t�L �f , t✓CL <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: 0 COMMERCIAL <br /> USE OF BUILDING: <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK:$ SOC). 67`� <br /> NUMBER OF DEVICES(if low voltage): <br /> FIRE ALARM? 0 YES 0 NO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIPTION OF WORK: I.SCOi,a -c'` Y. 120.601--1-.1(5 pO(1)l.(Z 14)(12yhh."�/ <br /> 1 / <br /> "L^/tAvCt i!J"Vi/hGks <br /> CONTACT INFORMATION <br /> OWNER NAME: a - 114E &UST u� TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET 15-"ZrL�. /44-tat�/L I/( biz <br /> CRY t/L STATE 4- ZIP ZO <br /> OWNER PHONE: Yz-r- 2:31 - 171-7'OWNER EMAIL: <br /> CONTRACTOR NAME: "V( ,(Z t2(„"Z�'1� (f lr/ A <br /> CONTRACTOR ADDRESS: STREET Si ZC A Cc t e. <br /> are pi ,l STATE I:e% Q� <br /> . ZIP Z�7) <br /> CONTRACTOR PHONE: 47_6'_'25"x.—31/i+ CONTRACTOR EMAIL: kgi' ,) 5.S7fl1 4 -4 49111 <br /> CONTRACTOR LIC.#(REQUIRED):a>CV26S5CrZZ ` CITY OF EVERETT BUSINESS LIC.#(REQUIRED):5O7gcc <br /> PRIMARY CONTACT: 0 OWNER CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: x ;.. ..- 7/ref <br /> 4 ' j SAL CONTACT EMAIL: k ; L�a�d ie . cool <br /> AGREEMENT:I hereby certify that 1 have read and examined this application and know the same to be true and correct. All provisions of laws and 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 /> PERMIT# <br /> (5?4/4 <br /> ii� . E 1S11 -042. <br /> Owner/Authorized Agent Signature Date (Revised 9/23/2016) <br />