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4-rr 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: , V. 12 -C�'t� ,ty �'Ul, j
<br /> BUILDING AREA(if residential,new construction,remodel,or addition) V1' arnli a 1 SF
<br /> BUILDING TYPE: SFR-DETACHED 0 SFR-ATTACHED 0 DUPLEX 0 MULTI-FAMILY-#OF UNITS: 0 COMMERCIAL
<br /> USE OF BUILDING:
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<br /> CONTRACT PRICE OF WORK: $ DD..'”
<br /> NUMBER OF DEVICES (if low voltage):
<br /> FIRE ALARM? ❑YES ❑NO
<br /> ASSOCIATED BUILDING PERMI^T# if applicable): ` ( '�1 A ` j� j�
<br /> DESCRIPTION OF WORK: 00 1T-�� NC( ov WTI(' :0f iI UfA O°Ia Ut�r(Oi r Io�
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<br /> OWNER NAME: 12,0 4111 (J( TENANT NAME(If Commercial):
<br /> OWNER MAILING ADDRESS: STREETST3 I I�,,,,KW 41 A/ �. p �}
<br /> CITY F.Vtir STATE(hit-r� ZIP a/}V 1.
<br /> AT: LI 5i q( VV 11ff VV
<br /> OWNER PHONE: �, OWNER EMAIL:
<br /> CONTRACTOR NAME: , l��, nte,
<br /> *0
<br /> CONTRACTOR ADDRESS: STREET1I I Cp��//110441 (T- l60 !. g/ 11
<br /> CITY��/i/�g ��/r -tT.e...iv ce STATE ��/rI ZIPggOtCONTRACTOR PHONE: �Z` 'i1 10CONTRACTOR EMAIL: vvvvvv ��//
<br /> CONTRACTOR LIC.#(REQUIRED) uErF a3 06t. CITY OF EVERETT BUSINESS LIC.#(REQUIRED) 05Z160
<br /> PRIMARY CONTACT: 0 OWNER 3-CONTRACTOR 0 OTHER(Please Specify)
<br /> CONTANAME: I CONTACT PHONE:771 - L l
<br /> oo kV l , / �(/ 9( , CONTACT EMAIL:
<br /> AGREEMENT:T hereby certify that I have re d and e a nined 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 spe red herei r 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 /> FEE
<br /> kr.1-5 e.%?
<br /> 4 PERMIT#
<br /> / , E V\.—1
<br /> Ownereut, rized Agen I, , r= Date (Revised 10/12/2015)
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