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ELECTRICAL PERMIT APPLICATION <br /> IAS 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 www.everettwa.gov/permits <br /> PROJECT SITE INFORMATION , <br /> PROJECT ADDRESS: �jOO 5 \,J l��� CV) C�• (''w k) ;DIY L1 C)-5(4, iI 4 ( QC N <br /> BUILDING AREA(if residential, new construction, remodel, or addition) SF <br /> BUILDING TYPE: 0 SFR <br /> -DETACHED 0 SFR-ATTACHED 0 DUPLEX 0 MULTI-FAMILY-#OF UNITS: >SCCOMMERCIAL <br /> USE OF BUILDING: 1C Jrt'('1(A\ <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK: $ '332I-1( <br /> NUMBER OF DEVICES (if low voltage): <br /> FIRE ALARM? o YES y( NO <br /> ASSOCIATED BUILDING PERMIT# (if applicable): <br /> DESCRIPTION OF WORK: hiSfi�,)'\ �014-101 I ��, C�; Cti lc� �i�C� o! P1�-.i CA <br /> c t L.J\ r'r \) J c,A <br /> CONTACT INFORMATION <br /> OWNER NAME: -MA, ;rkg :"n Q(nsly TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET <br /> CITY STATE ZIP <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: Gam+)-I-cc\ Dy nr^M;1 (ice <br /> CONTRACTOR ADDRESS: STREET 2 I' `r (/' \) t ) 062,CITY STATE lv") <br /> 41 ZIP 9 ).-U <br /> CONTRACTOR PHONE: ur�5--SI 5-G(CSI CONTRACTOR EMAIL: CO+'t-t-C..c-t( (j ;n"). coin <br /> CONTRACTOR LIC.#(REQUIRED): COOTK .. f (}7 CITY OF EVERETT BUSINESS LIC.#(REQUIRED): <br /> PRIMARY CONTACT: 0 OWNER y CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: 29L;-%17-Lf S0 <br /> q IG�O� MCD6 c-I CONTACT EMAIL: <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 /> DI 31 1(n E (,io5 <br /> Owner/Authorized Agent Signature Date (Revised 923/2016) <br />