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I ba�74�;. 770%01c) <br /> ELECTMAL PrERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT,WA 9820I <br /> (P)425-257-8810 j FAX 4.25257-8857 j (E)evere#eps@evereftwa.gov WWW.eve e gov perm r dwa I its <br /> PROJECT ADDRESS: di I LA -Z <br /> WALDING AREA Cif residential,new construction,remode),or addition) SF <br /> BUILDING TYPE. 0 SFR-DETACHED El 8FR-A17ACHED 11 DUPLEX L1 MULTI-FAMILY-#OF UNITS: <br /> COMMERCIAL <br /> USE OF BUILDING: <br /> Lout 0 <br /> r <br /> CONTRACT PRICE OF WORK-$ <br /> NUMBER OF DEVICES CIF low voltage):- <br /> FM ALARM? 11 YES 51 NO <br /> ASSOCIATED BUILDING PERMIT# if applicable): <br /> Dr=sGPjPTiON OF WORK: <br /> IOWNER NAME: TENANT NAME(if Commercial): <br /> OW <br /> NER MAILING ADDRESS. =EETFi9 W>( 37/)7 <br /> OWNER PHONE: MAIL.: <br /> CONTRACTOR NAME." <br /> CONTRACTOR ADDRESS: P0 Box -449 <br /> jGONTRAGTOR PHONE: CITY In or-ILIZ�� STATaVJ9- <br /> 26-214-6144 1GONTRACTOREMAIL. .kAti <br /> CONTRACTORI-IC.4(REQUIREID): 07- ICITY Ol~EVERETT BUSINESS LIC.t(REQUiriED):04D5'�9 <br /> PRIMARY CONTACT; 0OWNER IKCONTRAGTOR 0 OTHER(Please Specify) <br /> CONTACT NAME-. GO NTAGT PHONE: <br /> L—. -DI�71q 1415 6&)W I GO NTACT EMAIL DENN IS. A 0 14)k9 k1k-1411 T- C—'DM <br /> AGREEMENT Thereby certify that I have read and examined this appficaffon andkoow1be same to be fiva and correct All provisions oflawsandordioances-govemTngthis <br /> type ot work wYlbe completed whether-spedfiedherein or not. The grunting ofapwmffdbes not presume fo give auffiorttvio violate or cancel the provisions ofanyotherstQtg ai <br /> lDwilaw regulating cousttvcfloj7or the performance ofoonstivctfon. That am authorized bythe ownerof thispropedyio perform the work for which sppffbaffon is made and I <br /> comply.with the State Contractors law 16.27RCW&ad296.god VIAC. <br /> City of.Everaft officlal Use Only <br /> FEE <br /> PERMq# <br /> E ) ��2-�2g� <br /> Signature Date (Revised 1011212015) <br />