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.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 I (E) everetteps@everettwa.gov I www.everettwa.gov/permits <br /> Pr-®Jg0 SEM fl NF©i G4i Tio <br /> PROJECT ADDRESS: f0I g �D S�. S Lc) cjt/C� � w P 943 `> <br /> BUILDING AREA(if residential,new construction, remodel,or addition) 5o 000 SF <br /> BUILDING TYPE: 0 SFR-DETACHED 0 SFR-ATTACHED 0 DUPLEX 0 MULTI-FAMILY-#OF UNITS: COMMERCIAL <br /> USE OF BUILDING: 9%-,A-4) -r <br /> ELECT•!CAC APPLICATION [INFO I'MATRON( <br /> CONTRACT PRICE OF WORK:$ I S 000+ -- <br /> NUMBER OF DEVICES(if low voltage): Z 0 <br /> FIRE ALARM? DYES 0 NO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIPTION OF WORK: 2 R _ 4�v✓IG11.0vt=�� I ELo <br /> ete,V ems l`kat.k c ha <br /> CONIT,k CT IN1F0A MA I tO <br /> 'OWNER NAME: .".R.06 (A)61/41.47.."- TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: srREEr /6=3)/tS g go '4 }' � ( J <br /> CITY OV�� STATE ("C ZIP [ 5 Zia 3 <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: Sf-O,.4.,c, ) Se-Gv+/+ I^✓ " k vt �O6,6Zvt <br /> l <br /> CONTRACTOR ADDRESS: STREET 2.-7OO K_L'c_"(_&v'c,(5 <br /> CITY : -/ _e STATE L!/ ZIP g5.c' <br /> CONTRACTOR PHONE:4 - 2-41.—Co O7 3 CONTRACTOR EMAIL: IJ .to Jig et2 %S b :-te. CO 01. <br /> CONTRACTOR LIC.#(REQUIRED): 'srAk/1/4,1I..S5 R(yr;Lj CITY OF EVERETT BUSINESS LIC.#(REQUIRED):Ito S S <br /> PRIMARY CONTACT: 0 OWNER._ $CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: 4 z- = 2- ( - (p 0/3 <br /> 1 <br /> Ke-,4 I' "Tobi a vi CONTACT EMAIL: Kg � (T ob & s <br /> AGREEMENT:T 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 <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 l am authorized by the owner of this property to perform the work for which application is made and <br /> comply with the State Contractors Law 18.27 RCW and 296.200 WAC. <br /> City of Everett Official Use Only <br /> FEE <br /> 06 <br /> PERMIT# <br /> 2- ei I) E tS() - (g <br /> Owner/Authorized Agent Signature Date (Revised 10/12/2015) <br /> • Z <br />