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ELECTRICAL PERMIT A kLICATI N
<br /> ,/04,,,oto,:./7:4_
<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: 3O(9 / 0,4i'<(5 ,4 It, 6.04 9 Is.g '1
<br /> BUILDING AREA(if residential,new construction,remodel,or addition) 119r-t P.../ SF
<br /> BUILDING TYPE: 0 SFR-DETACHED 0 SFR-ATTACHED 0 DUPLEX 0 MULTI-FAMILY-#OF UNITS: COMMERCIAL
<br /> USE OF BUILDING: Jh CS"{'"`-nj c-e .'
<br /> ELECTRICAL`APPLICATION INFORMATION
<br /> CONTRACT PRICE OF WORK:$ 2/tap°!%
<br /> NUMBER OF DEVICES(if low voltage):, 7WQ Q& V i '1- '�'•
<br /> FIRE ALARM? 'R YES CI NO r G 1 06'Q B I
<br /> ASSOCIATED BUILDING PERMIT#(if applicable):
<br /> DESCRIPTION OF WORK: WI rt'c v /i I.v/ /,UcZS ti,',..-ti 4''r 4616
<br /> --.1.4.'"'",......--,
<br /> 6c„te. iv/ 141AvAI-{ ,C'ev.L5 ",,-<- h ,U 2t¢./1+vtAii i," C. 513 t3 it.
<br /> CONTACT INFORMATION.
<br /> OWNER NAME: TENANT NAME(If Commercial):
<br /> OWNER MAILING ADDRESS: STREET
<br /> CITY STATE ZIP
<br /> OWNER PHONE: OWNER EMAIL:
<br /> CONTRACTOR NAME: t'4) Lr 7/ M
<br /> CONTRACTOR ADDRESS: STREET kr) ne, ,aciry Ed, �j`
<br /> CITY r/er// WPB,^ STATE ZIP /O 2 Z
<br /> CONTRACTOR PHONE: 3i..0 7!3 ��' CONTRACTOR EMAIL: `re,4 9E.{;v‹. e S L.LAt( „ eo,--L
<br /> CONTRACTOR LIC.#(REQUIRED): 14)/P E 71 4.t V 46- SP CITY OF EVERETT BUSINESS LIC.#(REQUIRED):
<br /> PRIMARY CONTACT: 0 OWNER RpONTRACTOR 0 OTHER(Please Specify)
<br /> CONTACT NAME: CONTACT PHONE: 36,. ........5-)6 C3�o1:=)
<br /> ,0 Ifq4 CA,4 CONTACT EMAIL: sr,, , tX.c',,rc p 9144atl , C2,'"N—
<br /> AGRFFMENT.•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/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 /> 11
<br /> PERMIT#
<br /> C ?,- )i.13,,t,,,e,,, e �t id \f6f..e- 1\l
<br /> Owner/Authorized Agent Signature Date (Revised 10/12/2015)
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