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12/19/2016 10 : 54 #1454 P. 002/002
<br /> ELECTRICAL PERMIT APPLICATION
<br /> A►/, CITY OF EVERETT PERMIT SERVICES
<br /> 3200 CEDAR STREET, EVERETT, WA 98201
<br /> (P) 425-257-8810 I FAX 425-257-8857 I (E)
<br /> everetteps @everettwa.gov I www.
<br /> everettwa.gov/permits
<br /> , 2 , ! . w!.; ...: .. g .,4140A4 " <0,0 .40:!1410S�iti:6( a ,? , ' ` .,, .
<br /> .
<br /> PROJECT ADDRESS: 2
<br /> YLNEAVIE 0 I!V' _ __
<br /> BUILDING AREA(if residential, new construction, remodel, or addition) SF
<br /> BUILDING TYPE: D SFR-DETACHED ILI SFR-ATTACHED Q, DUPLEX 0 MULTI-FAMILY-#of UNITS: ❑ COMMERCIAL
<br /> USE OF BUILDING: fr/
<br /> ...,„
<br /> _______
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<br /> 7.-„-,.ut,:zlM tr ". ., `"•:1..,-i.:1,..a.,...,. ?;(r0,*:ototoATcF[R;117Y(poi75,•L'S.Af?ti....,.,•li!;Tto.�Re.R�AtA.•,^T,.Aa74«a..no, ..., i. .,. ..,.<.. 6_•,..... ., ..r
<br /> CONTRACT PRICE OF WORK: $ .2,0.00
<br /> NUMBER OF DEVICES (if low voltage): _
<br /> FIRE ALARM? d YES El NO
<br /> ASSOCIATED BUILDING PERMIT# if a•.Iicable :
<br /> DESCRIPTION OF WORK: k 7.7
<br /> Ill ° /:.If ow 4 s FL1 / e_C
<br /> :...::IIES:wI,•°,.g > ,:,• • ,: ,, . • . .,.•, t ,•rar•d ,400.1t:40TGi.°N.100.01i4+RTIA, ,.. «., •. .. .,. . .. .,;`Il..
<br /> OWNER NAME: ,R/(f l 9 J. (C.,.t'p I TENANT NAME(If Commercial):
<br /> OWNER MAILING ADDRESS: STREEr R,92._3- g1Vat i fff IA-i /9 Vl?
<br /> CITY / - 1 ./ S7ATS £t I ZIP •//t®
<br /> OWNER PHONE: 142S 31/? 1e. OWNER EMAIL: y
<br /> CONTRACTOR NAME: F ✓1 !�f✓1F . ., 'C ;�iE '/<
<br /> CONTRACTOR ADDRESS: sl-RET ?r'i,{4�/F tiff 17– 1,4g-V ,
<br /> CITY tL/ `7 /(/L/STATE V ZIP 7420/
<br /> CONTRACTOR PHONE: /2c .2S9' c`/./.! CONTRACTOR EMAIL:
<br /> CONTRACTOR LIG. l..-.#4-Ai S Nei-4) CITY OF FVFRETT BUSINESS LIC.#(REQUIRED):a/42,4,y
<br /> PRIMARY CONTACT: ❑OWNER ❑CONTRACTOR ,(OTHER(Please Specify)) p� •Specify_,„ rV..
<br /> �k.,- Oe. )
<br /> CONTACT NAME:ICONTACT PHONE: (/) ' X7/ `y(
<br /> -fL—L.Li of CONTACT EMAIL:
<br /> AGREEMENT:T hereby cert/ry 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 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 /> FEE
<br /> PERMIT#
<br /> 4? /,‘A ,
<br /> Ownsr/ ihoriz d gent Signature Dat (Revised 10/12/2015)
<br />
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