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gri. RECTRICAL PERMIT AFRICATION
<br /> CITY OF EVERETT PERMIT SERVICES
<br /> 3200 CEDAR STREET, EVERETT, WA 98201
<br /> (P)425-257-8810 I FAX 425-257-8857 1 (E) everetteps@everettwa.gov 1 www.everettwa.gov/permits
<br /> f ' .wW 041 _ '� PitOJEVt� lNF®1RM 1. �'-_ ' - min L ins.
<br /> ,,,..: :::;;..7s.,taso . '� .+ ;: ,: ''I'',',11'.,,r ., .,,m e-,.m h>A -r v i ,,g,wi...> 4 m ,.,-, d<» - i . v1,4,,„:„... V
<br /> PROJECT ADDRESS: 1 l t D Y p p(a✓- SI-,
<br /> BUILDING AREA(if residential, new construction, remodel,or addition) L-/CYO SF
<br /> BUILDING TYPE: 0 SFR-DETACHED 0 SFR-ATTACHED 0 DUPLEX 0 MULTI-FAMILY-#OF UNITS: 0 OMMERCIAL
<br /> I
<br /> USE OF BUILDING: Q h._e__
<br /> � 'l:: 4 ELE II UCAL Ai Lididt thr Ooi tAA kM v M;' S* ,
<br /> �..'['Y.€<�3+A.N.D .wi�a'nn,)K ' ,_.. ,...a>s...,.,, .. .. :,,,,;.,‘„z,,:,„,,,„,:,. ..,,, :,,„,,,,,a,;,, ,;... ,„.,..:,.;,,,,4,1:,:-., :,,,h,,,,,.,,,,,� . .«e. e.wr, Rni.'�xA � . ,xwi \¢��,
<br /> CONTRACT PRICE OF WORK: $ 5 dey D
<br /> NUMBER OF DEVICES (if low voltage): ',5—
<br /> FIRE ALARM? 0 YES A NO
<br /> ASSOCIATED BUILDING PERMIT#(if applicable):
<br /> DESCRIPTION OF WORK: _✓t 5+.// P 7' l /A,".y ...e.--.IA Prbe., �4,1
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<br /> OWNER NAME: •--it.-- i'--1 .jam® ! ©is -4ric-t-TENANT NAME(If Commercial): kietiArtit-OWL-C.„
<br /> OWNER MAILING ADDRESS: STREET
<br /> CITY STATE ZIP
<br /> OWNER PHONE: OWNER EMAIL:
<br /> CONTRACTOR NAME: �o,(�,�,c) ee ��
<br /> CONTRACTOR ADDRESS: STREET 3(4)/y the t A_
<br /> CITY 3.A'C-I/^'e ( 4 STATE C4/4 / ZIP get 20
<br /> CONTRACTOR PHONE:1- S 3/4--Q 25-7 CONTRACTOR EMAIL: f'-,,..6,..,s L.,- g., 6? /-see to."-, .Ciz-wk
<br /> CONTRACTOR LIC.#(REQUIRED): J E,A Cb C lt-I D Q. 'CITY OF EVERETT BUSINESS LIC.#(REQUIRED) 6.0.„6,53"
<br /> PRIMARY CONTACT: 0 OWNER 12 CONTRACTOR 0 OTHER(Please Specify)
<br /> CONTACT NAME: CONTACT PHONE: `L(2 6—- I-S4/--0 ,S-13
<br /> AivG51— �ufb c) ,l., CONTACT EMAIL: emir s 1ti.e t /ISzG-CC.)r� . C04--1---...._
<br /> AGREEMENT.:I 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 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 I 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 /> --"'"k
<br /> 1-- PERMIT#
<br /> ,)i-/ E flo3 -A31
<br /> Owne Authorized Agent Signature Date (Revised 9/23/2016)
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