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grr CTRICAL PERMIT AP .ICATION `
<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 /> `,'„ h: { , _ , PROJECTS *:I NFQRM4TIOI!t R tl
<br /> PROJECT ADDRESS: Y-� ' -� " �-�-. , . _ .��� ,.�.
<br /> R 0 5 73 .5-1--r,62,,,,:21-- S., ,oleo ..
<br /> BUILDING AREA(if residential,new construction,remodel,or addition) SF
<br /> BUILDING TYPE: I11-4/R-DETACHED 0 SFR ATTACHED 0 DUPLEX 0 MULTI-FAMILY-#OF UNITS: 0 COMMERCIAL
<br /> %USE OF BUILDING: r as,l e bio C", p ,
<br /> x ELECTRICAL:AP,iPLI ATION INFOR UATIOq
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<br /> CONTRACT PRICE OF WORK:$ �,C j©,a o
<br /> NUMBER OF DEVICES(if low voltage):
<br /> FIRE ALARM? 0 YES 1-44406
<br /> ASSOCIATED BUILDING PERMIT#(if applicable): /1 /
<br /> DESCRIPTION OF WORK: i i,r - cdt-e `)j Nr c)v A� �e c\) c,?(r) A v» 1`c) ( ) L _ect- v^ of_i> /A C
<br /> x . .r :'•W V , ,, t; eek eq144 xWM Aga-V1.1 t CNTACT LNFORINATCON s S y es =} 4 y A U,*7 PVx `t
<br /> . ��.n. .s „..... . n,.�, „ E.,.,±x'�'+.�e,F k.,,..ctii k..F t \�.t r.. m .r ,.. ..,.... F ,As: ,z..._A_ ._ rx ovA ?vat
<br /> OWNER NAME: 'Y''( ca_,;, k bot K e___1(-- TENANT NAME(If Commercial):
<br /> OWNER MAILING ADDRESS: STREET
<br /> CITY / V 67 r"P:4+-(-, \ \ STATE(A )A ZIP 9 �(")a
<br /> OWNER PHONE: OWNER EMAIL: `oQ,cicf )c--) C/4Sc ,r v a: L..o ed rr�
<br /> CONTRACTOR NAME: &(, 4- : 6 c> -4 Le
<br /> CONTRACTOR ADDRESS: STREET/C1 i j sc '/t h AV e (..J 5i-e, 14 �y
<br /> CITY LLI/‘. i\ l,CN, ( STATE L� A ZIP / C) 3,
<br /> CONTRACTOR PHONE:Af D - 7 7 £{ - 7Oc m CONTRACTOR EMAIL: S �-
<br /> ►^��.c , iron c> 1 A Q '5���'ff�P -
<br /> CONTRACTOR LIC #(REQUIRED):ME L e,e�l Pk cit.QC__, __ CITY OF EVERETT BUSINESS LIC.#(REQUIReD)!'6 iterl r z
<br /> PRIMARY CONTACT: 0 OWNER CONTRACTOR 0 OTHER(Please Specify)
<br /> CONTACT NAM. CONTACT PHONE:
<br /> F�� a, os3 ���-�Z7� - 7O�C�
<br /> CONTACT EMAIL: nine LE(4,r, i C'. 0 �.s',c_er, cSC'c `fe el rd...
<br /> AGREEMENT:I 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 type Co r»
<br /> 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 /> -4—OwV , '1
<br /> s/7 , E cc--) —01-4-
<br /> Owner/Authorized
<br /> ner/Authorized A ent Si; ature Date (Revised 9/23/2016)
<br />
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