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ELECTRICAL PERMIT APPLICATION <br /> NNW -_,r 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 /> IPP2OJIECCT SITE INFO I it 'lATloOl <br /> PROJECT ADDRESS: -2--C.(?0 To t,J e( $4(.e P4 f )4,'✓\i e f /-/-‘11 /(7 <br /> BUILDING AREA(if residential,new construction,remodel,or addition) SF <br /> BUILDING TYPE: ❑SFR-DETACHED 0 SFR-ATTACHED 0 DUPLEX 0 MULTI-FAMILY-#OF UNITS: COMMERCIAL <br /> USE OF BUILDING \.e4.\/A4o d (313 (31.c;-• t <br /> ELECTRICAL APPLICATION INFO ATIION <br /> CONTRACT PRICE OF WORK:$ ii5i 000 <br /> NUMBER OF DEVICES(if low voltage): <br /> FIRE ALARM? ❑YES LNO <br /> ,ASSOCIATED BUILDING PERMIT#(if applicable): r <br /> DESCRIPTION1OF WORK: `KL.,f�/(-0&.4-- <br /> � rel6(,‘ 4,' IA's -Ft)t 6 O A 4{'41f e 4' <br /> L) k •\--k•• -lJ E(e iEA-0< ( .i •(© IE.k A <br /> b _ - <br /> 761411/7 P a --I ,44,4,—., <br /> CONTACT INF"RMAT1®N <br /> OWNER NAME: ,�CL TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: sTREEr 2.-000 T---0(,ie' 54-(ee-4- <br /> ve-<G+4- GJ,4y0z0 I- 90 <br /> ` � CrrY � STATE ZIP /� <br /> 1 OWNER PHONE: `f 25- -773 4.124 OWNER EMAIL: <br /> I CONTRACTOR NAME: g,(i K EI .[C'<--- <br /> CONTRACTOR <br /> t_CONTRACTOR ADDRESS: STREET /2/0 4 /z( ��^(-,Pi--4- ) <br /> CITY [1/1 <br /> ` \.( K I AN.- /4 'STATE ! ZIP g03 5( <br /> CONTRACTOR PHONE: -2 7a, (Q'70,1 CONTRACTOR EMAIL: 8,..0-. V lor i1n Ke_ie.„--!C\L ., c Dc-_. <br /> CONTRACTOR LIC.#(REQUIRED):11k)KE1-//d C CITY OF EVERETT BUSINESS LIC.#(REQUIRED):O� '$ <br /> PRIMARY CONTACT: 0 OWNER IZCONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT AME: 1/� CONTACT PHONE: 4.Z,S 7 q2,74,, ( 7 L) L <br /> -� I/1�\� t CONTACT EMAIL: de_ !a) /,trick 9 C <br /> AGREEMENT:T hereby certify that I 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 l 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 ROW and 296.200 WAC. <br /> City of Everett Official Use Only <br /> FEE <br /> • Z p0 <br /> :,,.,4 ( 2 <br /> 77 6//5---//i7 <br /> PERMIT# <br /> A0011111e. 4"`Owner Authorize.Agent Signature Date (Revised 10/12/2015) <br />