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477 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 /> PROJECT SITE INFORMATION
<br /> PROJECT ADDRESS: L{1 1.24 -221- (P . v G..k-
<br /> BUILDING AREA(if residential, new construction, remodel,or addition) SF
<br /> BUILDING TYPE: 0 SFR-DETACHED 0 SFR-ATTACHED 0 DUPLEX 0 MULTI-FAMILY-#OF UNITS: L.COMMERCIAL
<br /> USE OF BUILDING:�� �
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<br /> .:,.,,, .. /� i „// /ii. r6. .p r rr, it dp.,.r=,,.rr/r
<br /> //,//:� !///O%///%%!!%�',,.%//// is/i % ,. ,. ; /. �..
<br /> !/ /< // �c,,, e,.. �i,viii;-i coiai.,.,.:;,,.,
<br /> CONTRACT PRICE OF WORK$ ‘C�Cco ) G LF
<br /> NUMBER OF DEVICES (if low voltage): /
<br /> FIRE ALARM? ❑YES PK NO/
<br /> ASSOCIATED BUILDING PERMI if apcable):
<br /> DESCRIPTION OF WORK: \,7 11 1`Q,1► 6— L
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<br /> CONTACT'INFORMATION
<br /> OWNER NAME: H(�( -.f n':,• I('‘) TENANT NAME(If Commercial):
<br /> OWNER MAILING ADDRESS: STREET Li , z L-Pct- N_t!.\ /u� 2,01�9
<br /> CITY It G\fre eet 1( STATE IP 9 W 1
<br /> Z. LAO Z_ OWNER EMAIL 3 1k
<br /> OWNER PHONE:415 �� � �2,`� �d} '5���� Cez"
<br /> CONTRACTOR NAME: �� 1 �j ( I\10AUN(C4k-I jlJt�se-H `7C1--CTlC)
<br /> CONTRACTOR ADDRESS: STREET \L' lyCh 5Z j k b}-Ji � it Z.1y
<br /> e CIt
<br /> CITY 66A-TVL STATE '
<br /> ^ lam —`�1- ZIP l
<br /> CONTRACTOR PHONE:ZC)(O L ZO -j CONTRACTOR EMAIL: M� L C=TS t r}L Cc
<br /> CONTRACTOR LIC.#(REQUIRED): 01\)11 c- ;
<br /> ��T 1�` CITY OF EVERETT BUSINESS LIC.#(REQUI D) ,�rti x k}1A5,,
<br /> PRIMARY CONTACT: ❑OWNER Er.CONTRACTOR 0 OTHER(Please Specify)
<br /> CONTACT NAME: CONTACT PHONE: 2_0(c,.LAG` 60
<br /> 1 "(,Vv\ \ Q. Ci..`r,lCONTACT EMAIL: \�c�r.c I e iv1
<br /> AGREEMENT:I 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 type
<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 work 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 Only
<br /> 111. PERMIT#
<br /> _-
<br /> . rd,2}4. 11 E to . 2.H
<br /> Owner/Authorized Age t Si. ature 111 Date (Revised 9/23/2016)
<br />
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