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ELECTRICAL PERMIT APPLICATION <br /> NiNg CITY Q= `VERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT,WA 932OI <br /> (P) 425257-13310 € FAX 425-257-;357 = everatt-3ps@everattwa.gov evera.tapsQ@everattwa.gov I miAv.everettwa.goviparmits <br /> PROJECT.SITE-INFORMATION <br /> PROJECr ADDRESS: not_ ik,C, no', ' <br /> 'F <br /> 3UILDINv r <br /> AREA 1J?n,-4 -,a:,v . ,. ,, -, . <br /> USE l7`p✓Ji� � .s: A Ai" 1 "a DJ-3',..-:K '-.t �f I_! --AM:LN( �3- .���kJ VI14I , <br /> I <br /> ELECTRICAL APPLICATtON1NFORMA?ION <br /> CONTRACT PRICE OF WORK:$ <br /> NUMBER OF DEVICES if law vpitage): <br /> FIRE ALARM? 0 YES 0 NO --------f <br /> ASSOCIATED BUILDING PERMIT#(if a<piicable <br /> i► .11 -�.C�l, , <br /> I A ..!' , <br /> - >. _ : ,tcoNrAttt.ISIORMAtiON" <br /> OWNER NAME: ,. A r t <br /> OWNER MAILING ADORE33: 0 t. 0 Y P <br /> rrz,_* <br /> f ''�r r-L>e- 1 a <br /> OWNER PrtJNE t f} °r v J do . <br /> ai OWNER EMAIL: <br /> ODNTRAOTDR NAME: !y +' <br /> :O;NTRACTOR ADDRESS: 1 <br /> CONTRACTOR PHONE: s ` "1 baa ~ <br /> STATE tet' ZIP I` 2o) <br /> CONTRACTOR EMAIL: • /s +� 1 <br /> PRIMARY�AMF�`CIC:' (r Et��iIPE�rj:�l�'CEtl�- 116* is _ <br /> CITY OF EVERETT BUSINESS LIC,#(REQUIRED: a <br /> CONTACT: <br /> 0 OWNER h CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: <br /> CONTACT PHONE: aS 35Q D <br /> AGREEMENT:1 hereby certify that I have I .0010�C,examined this application and know the same to be true and correct. All provisions of laws and ordinances governing this type <br /> CONTACT EMAIL d Y 1'Cf •(Or?)fir <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 worn 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 Crly <br /> Os.' <br /> �,4,� PERMIT# <br /> C�nertalutherized Agent '4mature 1? "I <br /> Cate <br /> (Revised 9/2 Z:76) <br />