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141b7T 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
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<br /> PROJECT ADDRESS: ( � �?j03
<br /> BUILDING AREA(if residential,new construction, remodel,or addition) SF
<br /> BUILDING TYPE: 0 SFR-DETACHED 0 SFR-ATTACHED 0 DUPLEX lii-O LTI-FAMILY-#OF UNITS: 0 COMMERCIAL
<br /> USE OF BUILDING:
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<br /> CONTRACT PRICE OF WORK:$ 0 0 0
<br /> NUMBER OF DEVICES (if low voltage):
<br /> FIRE ALARM? 0 YES 0 NO
<br /> ASSOCIATED BUILDING PERMIT#(if applicable):
<br /> DESCRIPTION OF WORK: I(�J 6,t1,y'J i,_0 ( Y--
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<br /> OWNER NAME: N \,/1nrC/\,cD L-L'C-/ TENANT NAME(If Commercial):
<br /> OWNER MAILING ADDRESS: STREET LI2A 1 J ('f j� /�� ,{�
<br /> CITY ":,,x/r../vel STATE (& ZIP 1 `)�
<br /> OWNER PHONE: 4�S - 3' b� OWNER EMAIL:
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<br /> CONTRACTOR NAME: (3) I F16(--PA—e----
<br /> CONTRACTOR
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<br /> CONTRACTOR ADDRESS: STREET M1 I �U '2./2- -)P''
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<br /> CONTRACTOR PHONE:1---11- --71-1.(�r ,, t3 Jf1 CONTRACTOR EMAIL:(VV e LAAt uckyvC__C-'Wg �' T- G�`I'�'(
<br /> CONTRACTOR LIC.#(REQUIRED):131-M l� �v 5S-0 '� CITY OF EVERETT BUSINESS LIC.#(REQUIRED):O 2-al, e
<br /> PRIMARY CONTACT: 0 OWNER CONTRACTOR 0 OTHER(Please Specify)
<br /> CONTACT NAME: W CONTACT PHONE: "! '�r . --\--k l 3
<br /> t `��,(/vA 1 V , ` ( � CONTACT EMAIL: ,y,J_ ac .0S\.Jc----
<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 lam 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 /> FEE
<br /> 14 620 g:H,..---"'
<br /> PERMIT#
<br /> 1 CS.' o f I ri E nos - 13 1
<br /> Owner/Authoriz Agent Signatur, Date (Revised 10/12/2015)
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