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LECTRICAL PERMOT i PLC ATION <br />CITY OF EVERETT PER1111I VICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />(P) 426-257-8810 [ FAX 425-257-8857 ] (E) everefteps@everettwa.gov [ www.everettwa.gov/permits <br />S: 3 0 0 3 Cis .,,� o L\'� �- <br />!3L (� O "'3 a - <br />residential, new construction, remodel, or addition) SF <br />MG <br />i SFR DETACHED 13 SFRATTACHED El DUPLEX ❑ MULTI -FAMILY - # OF UNITS: <br />I� COMMERCIAL <br />: V w o <br />rs " Al,3iA'Cw�: w.5-+.`�G�.....:i'F:_:?.'..:'.�'.4.`.^..bx_c.�..tiK.R:4n..� .•j: <br />CONTRACT PRICE OF WORK: $ <br />NUMBER OF DEVICES (if low voltage); <br />FIRE ALARM? El YES S�NO <br />ASSOCIATED BUILDING PERMIT # (if applicable): <br />1 <br />DESCRIPTION -OF WORK: <br />- - .. COAd7`ACT i)i�FO1�MAT[UN'µ. - •_,�. - <br />FNEI NAME: a.G �0C'V-C �-� TENANT NAME {If Commercial): <br />OWNER MAILING ADDRESS: STREET 3 D ®"3 <br />(j <br />F� <br />crry J tre � <br />.. <br />STATE Zip <br />OWNER PHONE- <br />OWNER E-MAIL-. <br />CONTRACTORNAME:5e <br />CONTRACTOR ADDRESS: S-MEET <br />MY <br />STATE ZP � <br />CONTRACTOR PHONE: LIP 5' 8 1 L4 - f!v o 09 <br />CONTRACTOR EMAIL: <br />Q S L. In . ce yon <br />CONTRACTOR LIG. #(REQUIRED)- `j % p_ — C! <br />'1 _5 CITY OF EVERETT BUSINESS LIC. #(REQUIRED): 64 0 6Lt <br />_ <br />PRIMARY CONTACT. ❑ OWNER � IgCONTRACTOR <br />0 OTHER (Please Specify) <br />CONTACT NAME: <br />1 ( A _ 1 _ �� - <br />GONTACT PHONE: <br />CONTACT EMAIL'= <br />AGREEMENT' Gca$on and know the same to be true and correct All provisions of taws an <br />Thereby certify that I have read and examined this appd ordiriances governing this <br />type of work will be completed whether specified herein ornoL The granting of a permit does notpresume to give authority to violate or cancel the provisions of any other state of <br />locallawregulatfng construcffon orthe performance of construction. That 1 am authorized bythe owner of this property% perform the work forwhich application ismade and 1 <br />comply with the State Contractors Law 18.27RCWand 296.200 WAC <br />City ofEverett Official Use Only <br />FEE <br />PERMIITD# (Q % <br />Dvvner/AutY orized Agent Signature /'I--- Date (Revised 1011212015) <br />