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OP' ELECTRICAL PERMIT APPLICATION <br /> _' _�' <br /> CITY OF Et/_RETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> (P) 425-257-8810 I FAX 425-257-8357 j (E)evere".teps@eynrettvva.gov 4 www.everettwa.govipecmits <br /> * PROJECT SITE INFO MATION <br /> -z T'1 <br /> ?ROJECT ADDRESS. Mille "1 <br /> 3aU1LDING AREA 'f., J-)-1';. <br /> .J o ?fit -31,7 <br /> /3/ J'8.#J7n' SF <br /> 1)SE Or BJILDIN3:. <br /> ELECTRICAL APPLICtrib ;tI #0E#, {'I` N <br /> CONTRACT PRICE OF WORK: 'S '7 Cc' <br /> NUMBER OF DEVICES if low volta-5): <br /> ,FIRE ALARM? 0 YES 0 NO <br /> ASSOCIATED BUILDING PERMIT# if applicable <br /> • <br /> OWNER NAME; - , <br /> •- TENANT NAME if Co.ntlrartaf : <br /> 3WNER MAILtND ADDRESS: -rz % t 31 Ve) Sr - 1 2—O& <br /> srar_ P <br /> 7WNER P-fDN�: 5 '" <br /> / oil JIrErR EYSAfL: <br /> ^tUTRis:tT R,�A!�i <br /> O k - <br /> �O fTZA:T7R ADDRESS: t ,— - .�,.. <br /> 3Rizr i i 5 ?"D CC' <br /> carr i _ ( .. <br /> ":.:ONTRACTOR PHONE: STATE A A CP =I 120 I <br /> T s s.A"3 �s 0 1 CONTRACTOR EMAIL; <br /> (Ft UrRc''J):i' ��► $-t CITY OF EVERETT BUSINESS LIC.#(R QUIRSD): « <br /> PRIMARY CONTACT: ❑OWNER 67 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: <br /> CONTACT PHONE: L.:Q6 R54:1Ty V,.+ <br /> V <br /> AGREtJNkhIT.I hereby certify that I havV2k2ie. <br /> CONTACT EMAIL: deb;t. . 0 ine 'I •'c0r—) <br /> d examined this application and know the same to be true and correct. All provisions of taws and ordinances governing this <br /> of work will be completed whether specified herein or not. The <br /> local law regulating construction or the performance of construction.granting of a permit does not presume to gthi a properly to violate arcance/the provisions of any others a or <br /> type <br /> comply with the State Contractors Law 18.27 RCW and 296.200 WAC. at/am authcnzed by the owner of this property to perform The work(cm-which application is made and t <br /> City of Ev.erett Official Use Cnly <br /> ' PERMIT## <br /> -- � cuc , c . 2 -t E 11 I .. (52—D <br /> %�*enarrAutilcrized Agent S:gn,eture <br /> Cate <br /> (Revised 9/23/2016) <br />