|
LECTRCAL PERMIT AFTILICATION
<br /> ,� ,-1 - 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 /> BOCt, PROJECT SITE INFORMATION'
<br /> PROJECT ADDRESS:,...3174.0"--‘
<br /> .' 174.0"--‘if 4 W
<br /> BUILDING AREA(if residential,new construction,remodel,or addition) PJQ .3(QCOSF
<br /> BUILDING TYPE: 0 SFR-DETACHED 0 SFR ATTACHED 0 DUPLEX [MULTI-FAMILY-#OF UNITS: 4- 0 COMMERCIAL
<br /> USE OF BUILDING: Re � .
<br /> CTRICAL A LIGATION INFORMATION
<br /> CONTRACT PRICE OF WORK: '- (5g0
<br /> NUMBER OF DEVICES(if low oltage): `2
<br /> FIRE ALARM? 0 YES ZLNO
<br /> ASSOCIATED BUILDING PERMI • ' -•:' able):
<br /> DESCRIPTION OF WORK: keGt)/PSR (/r1;tr J
<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: /gfii/rereC.Q,vt 64.14/7/ tAJ y
<br /> CONTRACTOR ADDRESS: STREET O cI r� r /1)6(..)
<br /> CITY c i-.�r'C. STATE 64...)fr- ZIP
<br /> CONTRACTOR PHONE: CONTRACTOR EMAIL:
<br /> )Q CITY OF EVERETT BUSINESS LIC #R'QUIRED.
<br /> CONTRACTOR LIC,#(REQUIRED): �h2£Ft W /twin/ ( C � 1
<br /> ...,�,...,_.M..�....�..�.F...�.,w..�,..�.y..._....,,�...,,..�.,,�....-,....r.,.,,.,..,.._.�__., .., .�,r,...vn..,...,w.�..�..,.,,.wr_...»,,._,,,W_r.__�..�..r.._,._.V.,.�.w,,,..,.,.-�M.,..,.�x _-�.....�._,y_...� _..,.....,. ��„b.
<br /> PRIMARY CONTACT: 0 OWNER g99NTRACTOR 0 OTHER(Please Specify) s„r
<br /> CONTACT NAME: CONTACT PHONE: c-3 -9f �- 7/
<br /> /' e) a V” /
<br /> CONTACT EMAIL: je,y-t.3 %L() .4Gl - •„
<br /> AGREEMENT:T hereby tify that I have read and examined this application and know the same to be true and correct. All provisions of laws and ordinances governing thi
<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 of to 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 /> %ZSO
<br /> PERMIT#
<br /> _ o
<br /> (77 (a E \OO —OEg
<br /> Owner/Authorized Agent Signature •,:te (Revised 90/92/2095)
<br />
|