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01:77- 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 www.everettwa.gov/permits
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<br /> PROJECT ADDRESS: 332 SI-k-1 £vRAL- - A1-0- Loci
<br /> BUILDING AREA(if residential, new construction,remodel,or addition) d/ - SF
<br /> BUILDING TYPE: 0 SFR-DETACHED ❑SFR-ATTACHED ❑ DUPLEX 0 MULTI-FAMILY-#OF UNITS: ,COMMERCIAL
<br /> USE OF BUILDING: A ,s,•,ka,
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<br /> CONTRACT PRICE OF WORK: $ d,/ 7 yr,
<br /> NUMBER OF DEVICES (if low voltage):
<br /> FIRE ALARM? ❑YES EXNO
<br /> ASSOCIATED BUILDING PERMIT#(if applicable): II I'o q,
<br /> DESCRIPTION OF WORK: R ID(:
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<br /> OWNER NAME: TENANT NAME(If Commercial) v.tav+ 134^ Its
<br /> OWNER MAILING ADDRESS: STREET
<br /> CITY STATE ZIP
<br /> OWNER PHONE: OWNER EMAIL _.
<br /> CONTRACTOR NAME: ELECT - C {T)/ , ,NC
<br /> CONTRACTOR ADDRESS: STREET \Z°t t 2 aE,VE RL.y c),(\9-- RD
<br /> CITY M u l UTE° STATE \APA A ZIP 9U:19
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<br /> CONTRACTOR PHONE:42 5- ( , 2.--( 7 Q 1 CONTRACTOR EMAIL: PA RI E 1 E�`I 2I -CITY I NC.,COM
<br /> CONTRACTOR LIC.#(REQUIRED): ELECT f 1 1 Qj BP\ CITY OF EVERETT BUSINESS LIC.#(REQUIRED): 62.fab -3
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<br /> PRIMARY CONTACT: ❑OWNER CONTRACTOR 0 OTHER(Please Specify)
<br /> CONTACT NAME: CONTACT PHONE: 425- CD-797
<br /> PAt21.SA F-1 C tu\AP-Ds koN CONTACT EMAIL:
<br /> P76t121SA@ ELECTKI -CI,TY1NC. Cern
<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 t am authorized by the owner of this property to perform the work for which application is made and t
<br /> comply with the State Contractors Law 18.27 RCW and 296.200 WAC.
<br /> City of Everett Official Use Only
<br /> FEE
<br /> � ll
<br /> PERMIT#
<br /> ----� 2-/1 E I go6,- t 06,
<br /> Owner/Authorized Agent Signature Date (Revised 10/12/2015)
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