|
LECTRICAL PERMIT A 'U C TON
<br /> ,rr CITY OF EVERETT PERMIT SERVICES
<br /> 3200 CEDAR STREET, EVERETT, WA 98201
<br /> (P) 425-257-8810 j FAX 425-257-88571 (E) everetteps@everettwa.gov j www.everettwa.gov/permits
<br /> • PROJECT SITE INFOMATIOAI
<br /> PROJECT ADDRESS: Z4%3 L L e y
<br /> BUILDING AREA(if residential, new construction,remodel, or addition) SF
<br /> BUILDING TYPE: 0 SFR-DETACHED ❑SFR ATTACHED 0 DUPLEX 0 MULTI-FAMILY-#OF UNITS: I6 COMMERCIAL
<br /> USE OF BUILDING: "7, S
<br /> .
<br /> ELECTRICAL APPLICATION INFORMATION
<br /> CONTRACT PRICE OF WORK:$
<br /> NUMBER OF DEVICES (if low voltage):
<br /> FIRE ALARM? 0 YES 0 NO
<br /> ASSOCIATED BUILDING PERMIT#(if applicable):
<br /> DESCRIPTION OF WORK: eI72 -U/]-5 4-A).0 f-LfT1-i F1r4-17301- /.2La4;T.
<br /> :. : .. _4r - .. .. ..... ,1114F.. ... �. - .. ..... - . .. .. _ '.... ..
<br /> S /��� �- ,... _. COI�TACT� ORMATION`"
<br /> OWNER NAME: F-07-Di¢L� Zan- 5T 7& TENANT NAME(If Commercial): 6F-C G /'L
<br /> OWNER MAILING ADDRESS: STREET
<br /> CITY STATE ZIP
<br /> OWNER PHONE: OWNER EMAIL:
<br /> CONTRACTOR NAME: iw/r5 t —T1'zl(-
<br /> CONTRACTOR ADDRESS: STREET Po $0)( ,zgp0 Q
<br /> CITY �✓ TT STATE /40/4- ZIP W
<br /> CONTRACTOR PHONE: 475- - 25-2 - 4434- CONTRACTOR EMAIL: q✓f✓►/4ee_1fr, .G 9 H4al/i o/'1
<br /> r
<br /> CONTRACTOR LIC.#(REQUIRED): ..,L.ra/71 E/ 2830 CITY OF EVERETT BUSINESS LIC.#(REQUIRED): OZ49Ze-
<br /> w._...a.�,...,_...�-.�..,_.w._.,.......",...�,_...._K....�_�_�. .w,�....�,.�..,wd.�_...V.....,...,.,....v.,..,_,,,,,.�.....�,...�.,�....,..R�..,�.,w..�,..���..........®.,..._.�....�....o.�.,....._�..�,._..�....��..�-....a,.........,..r..,,......,.....ru....,..
<br /> PRIMARY CONTACT: ❑ OWNER gI CONTRACTOR 0 OTHER(Please Specify)
<br /> CONTACT NAME: CONTACT PHONE: 4 - ZJ,�.p - ITSU
<br /> Z T CONTACT EMAIL: (.5d4r7,76
<br /> AGREEMENT: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 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 /> FEE
<br /> •
<br /> G--7 (13
<br /> PERMIT#
<br /> •ffltA,
<br /> Owner/Authorized Agent Signature Date . (Revised 10/12/2015)
<br />
|