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"ow._ <br /> LLECTRICAL PERMIT AORICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> vie/O' - <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 I (E)everetteps@everettwa.gov www.everettwa.gov/permits <br /> PROJECT SITE INFORMATION . <br /> PROJECT ADDRESS: 2�/ ( t/J_ S c cI _fi <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: COMMERCIAL <br /> USE OF BUILDING: <br /> LECTRICALPPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK:$ - -- -7S, (90 d <br /> NUMBER OF DEVICES(if low voltage): <br /> FIRE ALARM? 0 YES Pi 0 <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIPTION OF WORK: <br /> • <br /> CONTACT INFORMATION <br /> OWNER NAME: p,„5-, 'FLGki--e TENANT NAME(If Commercial): A{ ` <br /> � -r <br /> OWNER MAILING ADDRESS: STREET /0 70 4 e q-t& PL L ) <br /> f� <br /> CITY Al 14 (`""'FFQ� I STATE ( - ZIP U Z <br /> OWNER PHONE: 4c ?j i sj ( 06 OWNER EMAIL: <br /> CONTRACTOR NAME: (ilk Ir' t ec-t ra, <br /> CONTRACTOR ADDRESS: STREET 3� (o 4-L 5T- <br /> CITY <br /> TCITY gV STATE ZIP Ar eg— <br /> CONTRACTOR PHONE: %2 6 S3 g 6, CONTRACTOR EMAIL: ��� a- (.I')e /e(- r rvi ,. 'n►v���5 A <br /> CONTRACTOR LIC;#(REQUIRED): (neAe( 162) gni( „CITY OF EVERETT BUSINESS LIC #(REQUIRED): d 5 33 n <br /> PRIMARY CONTACT: MINER CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: [lac-- 7' 5362 <br /> CONTACT EMAIL: <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 lam 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 /> FEE <br /> • S ,--- <br /> - <br /> PERMIT# <br /> _ / gbC — lag <br /> Owner/Aut orized Agent Signature Date (Revised 10/12/2015) <br />