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Jun 30 17 04:04p Mark Jensen/Imitative p3)862-7242 p.1
<br /> ELECTRICAL PERMIT APPLICATION
<br /> CITY OF EVERETT PERMIT SERVICES
<br /> ..481 .. .),
<br /> 3200 CEDAR STREET,EVERETT,WA 98201
<br /> (P)425-257-8810 I FAX 425-257-8857 I (E)everetteps@evereilwa.gov I www.everettwa.go '(permits
<br /> Hj1''' ! ! qPIO4E'..61r'itileWiti4740004)0V,'!. ..:.:::Y„ . !:';:. .:1'i''.;ii
<br /> PROJECT ADDRESS: i 4,0 -C.c, cl.\3 Q.../c ec\-, P„kr,\.\, \Ok")\:‘,..),\ \ Clair ea„.: , k .1.' r.-0
<br /> BUILDING AREA(If residential,new construction,remodel,or addition) SF d /!(
<br /> BUILDING TYPE: D SFR-DETACHED 0 SFR-ATTACHED 0 DUPLEX 0 MULTI-FAMILY-#OF UNITS: CEI.,,COMM CIAL
<br /> USE OF BUILDING:
<br /> IIIIW
<br /> IF,i4 .4r/N41cAiTIO4.V4FPRMWTOS'ig,:li :;:::
<br /> CONTRACT PRICE OF WORK: $ ., i 50
<br /> NUMBER OF DEVICES(if low volt:ge): I
<br /> FIRE ALARM? 0 YES 0 NO
<br /> ASSOCIATED BUILDING PERMIT# ' .•ilicable :
<br /> ti .._, A 1 t
<br /> DESCRIPTION OF WORK: IQ cii lacc„Gkic !. ,) k--\r Q.... ./(4,7), M c CN'IVA I ir‘ rm A I I cl;:/t , :' ft
<br /> ,...)
<br /> -. - COHTAGT INFORMATION
<br /> . .
<br /> OWNER NAME: C LA.1\-0 r-% 5 C TENANT NAME(If Commercial):
<br /> OWNER NIAILING ADDRESS: sme ,ni ( a0 Z.)C. E v P.4e.„.\-- \-- ..1 Ok 1460k VICIA:\I' (
<br /> Cir.( 'C.kt PirekV STAIE -... (AA. 21e
<br /> fl• ,07)
<br /> .01ANERptioNE: , , loy__ _InRTifk._._.._...................--------iL: .
<br /> CONTRACTOR NAME: ...: Iv\Q OceNV.‘vie.,_ ,-,,.,-NI --;7:Q,pv\-cz) 7e-ck• . . .
<br /> CONTRACTOR ADDRESS; ,,.‘ ,..1 I A .,._
<br /> sfileET 1 9 U 4 I c'ix i:,e,• V 01/4 of.s _PKW.v &I.e..
<br /> ..TySTKM b rirN A
<br /> ' / OXILiPtilraill.
<br /> Agallirffan1W-a:.
<br /> ,CONTRACTOR PI-IONE: . —?Ml-0;6 CONTRACTOR EMAIL.: U ' i +k/\c 1: OA 1/c.k. itil :aggiffla
<br /> CONTRACTOR UC.ft(REQUIRED): .71-0 kid 1A-T Ti k 4 CITY OF EVERETT BUSINESS UC.4(REM!AMEN
<br /> PRIMARY CONTACT: 0 OWNER t1 CONTRACTOR 0 OTHER(Please Specify)
<br /> •CONTACT NAME: , CONTACT PHONE:• ‘111111,tril,......
<br /> friOria 3c.. ,J CONTACT EIVIAIL; ' - - - frK. 04 i A 0 itA. k. es ,&72,przim
<br /> • -
<br /> AGREEMENT:I hereby certify that i have read and examined this application and know the same to be nue and correa Ali provisions of laws and orcitnancas governing this ryas
<br /> of work will be completed whether specified herein or not. The granting ea permit does not presbrne 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 applicotion 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 /> ? i
<br /> .4-4:-11------
<br /> L
<br /> 04dnirfAuthor zed Agent Signature Darla if-- ' 1 C•
<br /> Le I 1 1 PER ,
<br /> #
<br /> ' E VR-64-
<br /> (Revised 9/23/2(116)
<br /> 1 -2.-----
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