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477 tit ECTRICAL PERMIT APItICATION <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: 1.150 4 B('o ctiltAi <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: Service station/convenience store <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK: $ /6 C2 0, O 0 <br /> NUMBER OF DEVICES (if low voltage): <br /> FIRE ALARM? 0 YES 0 NO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIPTION OF WORK: 1,15)-0/1/ ( 3 ) Otat'rt-r-coy - fi-c pfetd-e5 4,-- <br /> Pc (�r�rit f '0 -e-.G ioicich r, J ei / , / ' ea5^e- <br /> 44' /��/Lr re, A <br /> CONTACT INFORMATION <br /> OWNER NAME: Ire,4/4/10) ,- ,6;:,j pa 0,144 AG TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET/ /8-O f /5,774,4,g <br /> CITY 6-ve / STATE ()L./4 ZIP q g-z--, ) <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: 410 T#STAY tL C ie(C/1 L. L.L.-C--- <br /> CONTRACTOR ADDRESS: STREET /6.9 j L/ 105 /,j/s"'t p / <br /> CITY 4it,"e,# STATEit," /�4 ZIP %(.ace f ce <br /> CONTRACTOR PHONE: 9U /4, 3 l /5'FC (CONTRACTOR EMAIL: <br /> C <br /> CONTRACTOR LIC.#(REQUIRED):pogo" L I-7$ a F CITY OF EVERETT BUSINESS LIC.#(REQUIRED):()SZ 7 9C/ <br /> PRIMARY CONTACT: 0 OWNER CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: Z 0 to, - g--5-11-4 g S---9" <br /> � <br /> Pte' 7 G� �G/iv1 SOY( CONTACT EMAIL: 'Ct4 440 fib t -k - e-G TS t .Cc>fy, <br /> AGREEMENT:I 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 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 /> .� — q U� 7Gf� E i o -oi3 <br /> Ow a Authorized Agent Signature Date (Revised 9/23/2016) <br />