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ELECTRICAL PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> (P) 425-257-881D I FAX 425-237-B357 [ (Es everetteos@everettwa.gov( www.everettwa.gov/Permits <br /> PROJECT SITE INFORMATION <br /> PROJECT ADDRESS: 46 !• Al I" <br /> 12.0 <br /> BUILDING AREA=f:asl3ntja r w 3,r, ::'Dr, nol a.ld,tDro <br /> SF <br /> _+ S-7R-D_I A3--rz-} !1 5- AT,- --,L -j -.t -t. 0 71-F' , <br /> JSE OF BJILJIN3 <br /> ELECTR#CAL'APPLU CATIONINFORMAtIC* <br /> CONTRACT PRICE Or WORK: $ ''5'c_D <br /> NUMBER OF DEVICES (if low voltage): <br /> FIRE ALARM? 0 YES 0 NO <br /> ASSOCIATED BUILDING PERMIT#(if applicable). <br /> DES GRIELIi)AL_OF t1LC2 r K: _ <br /> �l #- � _.,.... '�►; ,iii► , <br /> 'reON AcT MrORMm,ON <br /> OWNER NAME: <br /> CA TENANT NAME(IF Commercle1): <br /> OWNER MAILING ADDRESS: sre__r a ,► <br /> 1111012.. <br /> OWNER PHONE: VA, 5 5 + "� q S'7 OWNER EMAIL: <br /> CO,�T2ACTDR NAME. 1 rR <br /> r-auT.R.A;TOR ADDRESS: l r P Tat-pack <br /> 3T23.r <br /> CITY <br /> STATE YiJ i A 7�y".t"' LIP C(: 20 I <br /> CONTRACTOR PHONE: • "Agog 4r704 CONTRACTOR EMAIL: ! ,� <br /> CONTRACTOR'L{C:`�RvQEltt� � �':.� .ii �� rr ` � ✓Y► <br /> e <br /> ITV OF EVERETT BUSINESS LIC.#REQUIRED): 11,711 <br /> PRIMARY CONTACT: 0 OWNER rt CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: <br /> I € � (� CONTACT PHONE: t 5 a5 <br /> at {^ <br /> (C.` CONTACT EMAIL: deb 3( Y t .02)1("\I <br /> AGREEMENT:I hereby certify that I have read and examined Ihls application and know the same to be true end 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 /> CtUVOko .30 .E F <br /> Cwr:ertAtithorized Agent Signature ` I <br /> Cate <br /> (Revised 9/23/2076) <br />