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<br /> ELECTRICAL PERMIT APPLICATION
<br /> °I.11P00/444,1/---A.
<br /> ,virtg":" 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@everettwagov I www.everettwagovipermits
<br /> PROJECT SITE INFORMATION
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<br /> PROJECT ADDRESS: /j ) 5 f, . akci t-c) i..41 .ki.../o ye if, ,„ ,, -2
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<br /> BUILDING AREA(if residential, ,!vcons_trt4ion,remodel,or addition) SF 2.2- `-V
<br /> BUILDING TYPE: 0 SFR-DETACHED Q.SFR-ATTACHED 0 DUPLEX 0 MULTI-FAMILY-#OF U TS: 0 CO_ ERCIAL
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<br /> USE OF BUILDING: V-iLS‘ riaNA:\t,1/4..k
<br /> ELECTRICAL APPLICATION INFORMATION
<br /> CONTRACT PRICE OF WORK:$ ‘C).,,,
<br /> NUMBER OF DEVICES(if low voltage):
<br /> FIRE ALARM? 0 YES iiiNO
<br /> ASSOCIATED BUILDING PERMIT#(if applicable):
<br /> DESCRIPTION OF WORK: \j‘.-.1\'‘`Ik' , `N Q,S•c-.) -..,.•)\'‘C\re)\-Q Ce.3.-NrsA,.'\,\,)\,) \if)ISYY1-1-
<br /> CONTACT INFORMATION
<br /> OWNER NAME: Ci - L.. E LA/A v„..)iy:A,Q, ks--4-r- TENANT NAME(If Commercial):
<br /> OWNER MAILING ADDRESS: STREET 0kA3L3/4 \-A 7,,t\).0 1... . i\g,, ,,o, t,,,,,t_ ri,,,kic
<br /> CITY PSI(V V\e'S STATE\,..,0 C:;,)1, DP 'el C12 .j)
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<br /> OWNER PHONE: 314A) - 1 0 51•A • 0 1,c)1 'OWNER EMAIL 0)72_ Qt,-1,--\\ ,,,,,00z-t.).-E) Vo4k. , Q.j„)vyl,
<br /> CONTRACTOR NAME: NU---0,12/(‘
<br /> CONTRACTOR ADDRESS: STREET\\SA C )
<br /> CITY M \\ \INSSI\it"\ STATkij\'' ZIP CldS' 12,:),)
<br /> . . ,CONTRACTOR PHONE: IAa , . ';A4-1. - 4,.,.,.
<br /> .-'CONTRACTOR EMAIL: a c)of ko.V\ V(totet- v\Ga%Ivo ., 1/411,'
<br /> CONTRACTOR LIC MREQUIRED _ n (
<br /> -- ,L. L-I: ,1*-JCITY OF EVERETT BUSINESS LIC.ii(REQUIRED):C)5q ly(
<br /> PRIMARY CONTACT: DOWNER ONTRACTOR 0 OTHER(Please Specify)
<br /> CONTACT NAME: CONTACT PHONE: Z-"V..\. 9:2_,t6"
<br /> NINCCX-V\111\r'i \-\. CONTACT EMAIL:Nivsr \ika yA 2 (1) Q \.,,c, ,e t,,ODC6ITCA
<br /> AGREEMENT:!hereby certify that I have read and examined this application and know the same to be true and correct. Al!provisions of laws and ordinances governing this type
<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#
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<br /> • 1 ' ‘../'-,- 6t7;7:c'''. ,V E l So 2
<br /> ner/Autho*zed Agent Signature Date (Revised 9,2312016)
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