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LLE TRIC L PERMIT APPLICATION
<br /> h ' ter. 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 /> PRiO�IECT•SITE INPORMA,TIOi�I . :,.. ...
<br /> PROJECT ADDRESS: SI yy p
<br /> I` E � �' (��°�E_.g' 4}r e,,..,e,, e..4-f-, k,()
<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: Ci COMMERCIAL
<br /> USE OF BUILDING: j
<br /> ELECTRICAL APPLICATION IRIFORMATiO$
<br /> CONTRACT PRICE OF WORK:$ 3 -'5 , 0 C
<br /> NUMBER OF DEVICES (if low voltage): •
<br /> FIRE ALARM? 0 YES 0 NO
<br /> ASSOCIATED BUILDING PERMIT#(if applicable):
<br /> DESCRIPTION OF WORK: ; C.A.; af t-A.A.X ' X t c 1 I i 1,1 1 OCA Ot C c c, -. t6;.,„ r.L./0(a,.C. " L- `i'{"t—
<br /> j L c�tio f. ,,:_,t.1,,. 'C&. (,. (,'1. vA„.�t e t.
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<br /> CONTACT INPORMATIC?N . .• '
<br /> OWNER NAME_:. .Ka,ll',. .lcv 0r CX... - vk e:.- TENANT NAME(if Commercial):
<br /> OWNER MAILING ADDRESS: STREET t 1 (I (.,. (.t.'tta rte, S i IAA CITY [ +' 6'- STATE 8,�-,✓r1 71P CI S ) .d'
<br /> OWNER PHONE: ' B ? , ,..4-''"'? 2 F OWNER EMAIL: I a t I' . ,` pej t o . .i t 41,-,
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<br /> CONTRACTOR NAME: PCS( . ' t iNib,
<br /> CONTRACTOR ADDRESS: STREETPC ` X, 16)8_3
<br /> crrY 51V- V STATE A ZIP 4& "'C
<br /> CONTRACTOR PHONE: t4 ZS .'C CONTRACTOR EMAIL: bi,ct ite 1. ,W C l 01.4 iat i.;. tqw,
<br /> CONTRACTOR LIC.#(REQUIRED): 130C ei r CITY OF EVERETT BUSINESS LIC.#(REQUIRED):G �'71
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<br /> PRIMARY CONTACT: 0 OWNER 171,CONTRACTOR 0 OTHER(Please Specify)
<br /> CONTACT NAME: CONTACT PHONE: ` 1,c :5 ei`7 cs'' it ; -
<br /> `, i I C. )I:;C;,1 CONTACT EMAIL: t:-^"05c I e", i C(ti_ ivr ,(` CAA La; k , C. , HA
<br /> AGREEMENT:T hereby certlfythat 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!em 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 /> '"-'} PERMIT#
<br /> f V 0(1 - 1W
<br /> Own r1 utlicrlzed Agent Signature D to (Revised 10/12/2015)
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