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ELECTRICAL PERMIT APPLICATION <br /> -' CITY O,'= EVERETT PERMIT SERVICES <br /> (P) 425-257-8810 FAX 42J-25T-g 7 3200 <br /> CEDAR STREET, EVERETT.WA 98201 <br /> c ( (E)ev r. t ps@everetb,va.gov E www.everetttiva.govfpermits <br /> PROJECT Site INFORMAT1t3N <br /> PROJECT ADDRESS <br /> 3+JtLDING AREA s;?5 `3 , .v ojns :t^t on or <br /> aJ . <br /> -y -µ <br /> SF TYPE' 7' 3FR-DTA4J 0 37 0 <br /> 0;�f'JI_TI�=AI�:ALY- U",(:73, 0 COMM <br /> JS=OF 3UELDEN3: <br /> ELECTRICAL=APPLICATION FNF.ORMl tit'3N <br /> CONTRACT PRICE OF WORK: $ 5 ear <br /> NUMBER OF DEVICES(If low volta e): <br /> FIRE ALARM? 0 YES 0 NO <br /> ASSOCIATED BUILDING PERMIT At If applicable <br /> CtS:CR.tET[L?l...QF.'41CG?.1 £.:._ <br /> +► '...A <br /> ''';c0ittAbtitOtORMAtioN <br /> DWN!R NAME: <br /> TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: i $ 4 <br /> VIP <br /> 7,Ire <br /> DWNAER PHONE: 22.0 <br /> :DNTRAOTOR NAME: ayl <br /> ::'XNTRACTDR ADDRESS: 'i if <br /> D Of-1'rf <br /> CITY <br /> STATE \Aj,QI- <br /> ZIP 93 20 1 <br /> yONTRACTOR PHONE; ('; ,R <br /> fl1`1 . rr * CONTRACTOR EMAIL: 0 <br /> ____CONTRACTOR-M.##lE�E04lRED : nem r �� • r,. „mg , I � � r r 111,1PRIMARY CONTACT: 0 OWNER) CITY OF EVERETT BUSINESS LIC, REQUIi ED; r <br /> ............. <br /> si _. <br /> CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME; <br /> CONTACT PHONE: <br /> I PJ'i. CONTACT EMAIL: » <br /> AGREEMENT:l hereby certify that t have read and examined this application and know the same to be end Correct. All provisions of laws andordinances t governingthis <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 lam authorized by the owner of this property to perform(he work for which application is made and type <br /> comply with the State Contractors Law 18.27 RCW and 296.200 WAC. <br /> City of Ev.eretl Official Use Only <br /> PERMIT# <br /> 'et/a� f o r 30, E \ ()OZ <br /> CvrrertAuthcrized Agent Signature I <br /> Cate <br /> (Revised 9/23/2076: <br />