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tLECTRICAL PERMIT APPLICATION
<br /> -410,41rw CITY OF EVERETT PERMIT SERVICES
<br /> 3200 CEDAR STREET, EVERETT, WA 98201
<br /> (P)425-257-8810 j FAX 425-257-8857 j (E)everetteps@everettvvagovi vvwvv.everettwa.gov/permits
<br /> PROJECT SITE INFORMATION
<br /> PROJECT ADDRESS: .-in ',11 - --S.E EV:34 (- 1----t- IA f\cL ( :2- .4
<br /> -,--7±7.—
<br /> BUILDING AREA(if residential, new construction, remodel,or addition) SF q
<br /> BUILDING TYPE: 0 SFR-DETACHED 0 SFR-ATTACHED 0 DUPLEX 0 MULTI-FAMILY-#OF UNITS: 0,COMMERCIAL
<br /> USE OF BUILDING: (9/9:56
<br /> ELECTRICAL APPLICATION INFORMATION
<br /> AMI••••••••••• •••••Nom.mmimmmmnmr.............. ram•m••••mm...
<br /> CONTRACT PRICE OF WORK:$ _.,.--T.For.,,,
<br /> NUMBER OF OF DEVICES(if low voltage):
<br /> FIRE ALARM? 1YES 0 NO
<br /> iv er, .,...
<br /> ASSOCIATED BUILDING PERMIT#(if applicable): igirto(,)13 Li )
<br /> DESCRIPTION OF WORK: ef> ,/rh:',/ iz:Zelvor-s-ce,9, ,J7n,f),-;97,,,,
<br /> ,, ri• i
<br /> /7)37-'4 4 /7-564) 6-lf e.:1
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<br /> CONTACT INFORMATION
<br /> OWNER NAME (RA, 19/:: <ue-f-'.6e..4-- Ett,:,, ----e1Y- TENANT NAME(If Commercial):
<br /> -,
<br /> OWNER MAILING ADDRESS: STREET
<br /> CITY
<br /> STATE ZIP
<br /> OWNER PHONE: OWNER EMAIL:
<br /> /-1
<br /> CONTRACTOR NAME: rfr"frie 1 Oci9isu 4----Vek..:17'e ci911 (..,c1,7 77-4.--civ/-
<br /> CONTRACTOR ADDRESS: STREET /3"'S3n 3 7 ,-7-tie- i'v'e--
<br /> cfry -17e-17-777e_
<br /> S1 A TE e:4/119- ZIP
<br /> CONTRACTOR PHONE: c'..2 6)6-6 7,9- !.?..5--177 CONTRACTOR EMAIL: /5/./.7c.7?. 4./6/20vp_,A.--.0m(LI,-" .f 7 iU l'---
<br /> CONTRACTOR LIC.#(REQUIRED): AI f9,4(le c ,y91;,,r2f: CITY OF EVERETT BUSINESS LIC a1(REQUIRED):05 3-7 •1- 9
<br /> PRIMARY CONTACT: 0 OWNER '-ja CONTRACTOR 0 OTHER(Please Specify)
<br /> CONTACT NAME: CONTACT PHONE: xl()6 -67 :7-9- 7r7
<br /> 4'9/9 f?e-1/
<br /> s i, CONTACT EMAIL:
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<br /> AGREEMENT:Thereby cer*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/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 ROW and 296.200 WAC.
<br /> City of Everett Official Use Only
<br /> FEE
<br /> ( 7 . 0 ()
<br /> ,---
<br /> e,-7
<br /> PERMIT#
<br /> Owner/Authorized AgentSIgnaturfy Date (Revised 10/12/2015)
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<br /> Nj
<br /> 4 — ,
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