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<br /> ELECTRICAL PERT LIT APPLICATION
<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 /> PR rJECT SITE INFO I'-;MATZO N9
<br /> PROJECT ADDRESS: 1 5g-00 `-L44J,EA- v r (�T 2 - p 243 I
<br /> BUILDING AREA(if residential,new construction,remodel,or addition) 5-76='D SF
<br /> BUILDING TYPE: 0 SFR-DETACHED ❑SFR-ATTACHED ❑DUPLEX ❑MULTI-FAMILY-#OF UNITS: ❑COMMERCIAL
<br /> USE OF BUILDING: d-C-7/14VZ/Z S
<br /> EL,EC'TRICAL,APPILICATI FORMATION
<br /> CONTRACT PRICE OF WORK:$
<br /> NUMBER OF DEVICES (if low voltage):
<br /> FIRE ALARM? ❑YES 1 NO
<br /> ASSOCIATED BUILDING PERMIT#(if applicable):
<br /> DESCRIPTION OF WORK: GSA- a t,rco,4
<br /> • CONTACT INFORMATIO• N..
<br /> OWNER NAME: �/Gf� isteb/+ft�4"�"//-�[� 04 4.TENANT NAME(If Commercial):
<br /> OWNER
<br /> MAILING ADDRESS: STREET PCP 73e7X 1..A2T4- 5 6 ,-/6— l ?1
<br /> CST{ VON STATE
<br /> OWNER PHONE: OWNER EMAIL:
<br /> CONTRACTOR NAME: A/LJ/2-/ --
<br /> CONTRACTOR ADDRESS: sTREEr /2e 2
<br /> CITY rfn!riff e S STATE / - ZIP G 2-Z I
<br /> CONTRACTOR PHONE: 560 4e/O s"a CONTRACTOR EMAIL: /741-1/2-/bY'a 6C---71 LLG�/t` e ykk,a
<br /> CONTRACTOR LIC.#(REQUIRED) / U1'Z E sr30 ; CITY OF EVERETT BUSINESS LIC.#(REQUIRED)
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<br /> PRIMARY CONTACT: ❑OWNER AONTRACTOR 0 OTHER(Please Specify)
<br /> CONTACT NAME: CONTACT PHONE: `��� �CU� i4
<br /> Ae-ic•c-7 CONTACT EMAIL: ffv� �lG=-i��LGCC)/� 4-Za0_C67yCL
<br /> AGRFFMENT: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 l am 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 /> PERMIT#
<br /> �� (� E ill - / 0
<br /> Owner/Authorized Agent Signature Date (Revised 10/12/2015)
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