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10:77- ELECTRICAL PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 1 (E) everetteps@everettwa.gov www.everettwa.gov/permits <br /> PROJECT SITE INFORMATION <br /> PROJECT ADDRESS: 100.3 eSk (c.‘&( -GCA b\eve�k i W ca2 c7j <br /> BUILDING AREA(if residential, new construction,remodel,or addition) 1 ,16 SF <br /> BUILDING TYPE: ❑ SFR-DETACHED 0 SFR-ATTACHED 0 DUPLEX 0 MULTI-FAMILY-#OF UNITS: igCOMMERCIAL <br /> USE OF BUILDING: 'le() CGCIII Il Gr\kVl\ vlt,�Y ( ccrl'o S <br /> ELECTRICAL APPLICATION INFORMATION �\ <br /> CONTRACT PRICE OF WORK: $ S (5 I (ty \)1) <br /> NUMBER OF DEVICES (if low voltage): <br /> FIRE ALARM? ,®;YES 0 NO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIPTION OF WORK: erty: w..;e.' r I(C hk A2 , (Oil\ _� '1 atrt <br /> •Ei;rSt�1'r-« h k f-0,cA r , \\v6\ Y ou\Th ul,a 0C-F Verkt,O(*i ,11 cJ 5 -(Z <br /> 1?W1.Atn), <br /> CONTACT INFORMATION <br /> OWNER NAME: 1'(\2 tl qryTENANT NAME(If Commercial): ( C\ l'9 <br /> OWNER MAILING ADDRESS: STREE (DO k� . (rte jvTskc�C `_ <br /> CITY 0.'11U-up STATE IT[ ZIP (Ob(DOib <br /> OWNER PHONE: / OWNER EMAIL: <br /> CONTRACTOR NAME: ccq cs4cAk e(Avic. <br /> CONTRACTOR ADDRESS: STREET I6 Cat S(- \f(� <br /> CITY �L.P O.�L STATE % ZIP 6(R'o <br /> CONTRACTOR PHONE: L4 LS- -C 0 ' I L 1 CONTRACTOR EMAIL: SC.Vfi( elai 9e,v- U Secl 140,\ ,LOvh <br /> CONTRACTOR LIC.#(REQUIRED): C U�c1'(..x;11m CITY OF EVERETT BUSINESS LIC.#(REQUIRED): ( ti}a Vy5 <br /> PRIMARY CONTACT: 0 OWNER CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: Lf Z$ -61 l;1 —(1,^l <br /> (15-CV) GL,Qh)e✓ CONTACT EMAIL: gcl r h C(c;,\I��y c &11 ihGYckk tom <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 /> E O(0- 2013 <br /> Owner/Authorized Agent Signature Date (Revised 9/23/2016) <br />