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ELECTRICAL PERMITIT APPLICATION <br /> 04:77.. <br /> CITY OF E.VERETT PERMSERVICES <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 /> t <br /> PROJECT ADDRESS: 1,4 q'5 0 VI 51Pk P.t @'e... <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: 0 COMMERCIAL <br /> USE OF BUILDING: <br /> Li + 'taIAJillilIN,fiRM ' cil <br /> CONTRACT PRICE OF WORK: $ 2.....50 •c° <br /> NUMBER OF DEVICES(if low voltage): <br /> FIRE ALARM? 0 YES 0 NO <br /> ASSOCIATED BUILDING PERMIT# if aeplicable <br /> - DESCRIPTION OF WORK:...... <br /> Cid 7 /2 c r- -I s a .� v <br /> ,.,,,u� <br /> -c <br /> OWNER NAME: G^( nekPLAA1TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET ""I _t \I L S1-A P L4Cf-, <br /> y� , <br /> ctr�r +.Q ;„Q�.�� <br /> � 2i STATE �f✓�^--1 ZIP q 263 <br /> OWNER PHONE: 2-0 " Ocp01 OWNER EMAIL: <br /> CONTRACTOR NAME: C, V-cLr1 0 C <br /> CONTRACTOR ADDRESS: STREET �I HIS. OQ.d4 ?f7a <br /> CIN ""C'"L--� STATE ' 21P 20 <br /> CONTRACTOR PHONE: to D r q i""' • CONTRACTOR EMAIL: • ' # # <br /> —CONTRACTOR EIC:"#(REOUIf'RED) CXXn fte- k'j—1-1- CITY OF EVERETT BUSINESS LIC,#(REQUIRED): r©Is 0. <br /> PRIMARY CONTACT: 0 OWNER rkCONTRACTOR 0 OTHER(Please Specify) <br /> — <br /> CONTACT NAME: CONTACT PHONE: 4'015 359 oto <br /> i ie CONTACT EMAIL: d 6 , htcm .(l, ) <br /> AGREEMENT l hereby certify that I have read and examined this application end know the same to be true end 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!am authorized by the owner of this properly to perform the work for which application is made and I <br /> comply with the State Contractors Lew 18.27 RCW and 296,200 WAC. <br /> City of Everett Official Use Only <br /> PERMIT# <br /> pe,b)24- ctit.m.;_5- "7—2.. Li' k Ca E RA -- 2H <br /> OwnerfAuthorized Agent Signature <br /> Date (Revised 9/23/2016) <br />