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ELECTRICAL PERMIT APPLICATION <br /> ,/14111///N1**;.--"i <br /> 4 . 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 /> PROJECT SITE INFORMATION <br /> PROJECT ADDRESS: . , `,,s,,n b a c)-,)-. 2-1(.., -3... . CLm '1 ` )L) <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: n 3 <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK: $1 [ 2,ebb' <br /> NUMBER OF DEVICES(if low voltage): <br /> FIRE ALARM? 0 YES ANO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIPTION OF WORK: 1 ,\5(-, C C 9 A +0,,-1- S (2_, S.? - <br /> CONTACT INFORMATION <br /> OWNER NAME: 1,jsc ` TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET <br /> CITY STATE ZIP <br /> OWNER PHONE: OWNER EMAIL,:, <br /> CONTRACTOR NAME: bvY 6 n PNC \ , � 55U` i1ca <br /> CONTRACTOR ADDRESS: STREET S7, �o 2.,3 1 Z.") 1 ij o <br /> CITY 'Nt .sSTATE \.J ZIP CA3 2(Dp <br /> CONTRACTOR PHONE:/'-12(_ 5L) -ee,.jQ7b CONTRACTOR EMAIL: "Vci e ( ( c6\...-•O PYA t <br /> CONTRACTOR LIC.#(REQUIRED):\. NQ % \\L-k(,, OF EVERETT BUSINESS LIC.#(REQUIRED):O3�PAZ, <br /> PRIMARY CONTACT: 0 OWNER 0 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTT NAME: CONTACT PHONE: f -- -s<.\ - � �� <br /> f V 44 <br /> vS ( CONTACT EMAIL: �vs fi �S�i^ 1\ <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 /> /i E do /-( <br /> Owner/Authorized Agent Signature Date (Revised 9/23/2016) <br />