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477 E —CTRICAL PERMIT APP1OCATION
<br /> CITY OF EVERETT PERMIT SERVICES
<br /> 3200 CEDAR STREET, EVERETT, WA 98201
<br /> (P)425-257-8810 I FAX 425-257-8857 1 (E)everetteps@everettwa.gov 1 www.everettwa.gov/permits
<br /> PROJECT SITE INFORMA,TIONe
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<br /> PROJECT ADDRESS: 3 L 1 8 Fr; /U moi.) o e
<br /> BUILDING AREA(if residential,new construction,remodel,or addition) SF I/ © L{
<br /> BUILDING TYPE: (FR-DETACHED 0 SFR-ATTACHED 0 DUPLEX ❑MULTI-FAMILY-#OF UNITS: 0 COMMERCIAL
<br /> USE OF BUILDING: Rpm ,A)G�
<br /> ELECTRICAL :04#CATION INFORMATION
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<br /> CONTRACT PRICE OF WORK:$ p p©. °
<br /> NUMBER OF DEVICES(if low voltage):
<br /> FIRE ALARM? 0 YES DI)
<br /> ASSOCIATED BUILDING PERMIT#(if applicable):
<br /> DESCRIPTION OF WORK: 4r, K.) r •,%LCC • ,
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<br /> OWNER NAME: An,rp p Pr TENANT NAME(If Commercial):
<br /> OWNER MAILING ADDRESS: STREET , LIP) Fr 0,1 tie,
<br /> CITY GVH(( STATE (t 14 ZIP 9kDr-V
<br /> OWNER PHONE. i.ta QC. 7 7 / n ,OWNER EMAIL
<br /> CONTRACTOR NAME: © G,� r Q Q l'-•E;cr' tr of z 1 Le
<br /> CONTRACTOR ADDRESS: STREET /901 � - (�, � )�}I j (�, 3 St)1-Fe 1--i •
<br /> CITY L-..`,.//i A Lt.") CDA STATE t p)A. ZIP 340
<br /> CONTRACTOR PHONE:',/ S-77y --7OQ 'CONTRACTOR EMAIL:r71refecA-A C©P rtoq S( 1 of mo,rL
<br /> CONTRACTOR LIC.#(REQUIRED):/iRELEEG89O ine CITY OF EVERETT BUSINESS LIC.#(REQUIRED):na5 corn
<br /> PRIMARY CONTACT: 0 OWNER ONTRACTOR 0 OTHER(Please Specify)
<br /> CONTACT NAM Th CONTACT PHONE: 771-1 7000 a
<br /> E nkr I,<©`3G CONTACT EMAIL:v,,,,,e,Ler
<br /> v- C'.0 t �Ir r e .�'SPn L�'_��8n-sta..`;
<br /> AGREEMENT.:I hereby certify that I have read and examined this application and know the same to be true and correct. All provisiong of laws and ordinances governing this type COQ
<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 /> PERMIT#
<br /> Owner/Aut orized Ag-- Sign ture Date (Revised 9/23/2016)
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