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14177 LECTRICAL PERMIT APIRICATION
<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 /> r//r/ r/ /,,,, !�//tri% / /�/%rri r /// / -�7i r;-a- r it/Sr i/ r / / �r %/�/ii/i r„
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<br /> PROJECT ADDRESS: 2 ( ( I l'5 1'
<br /> BUILDING AREA(if residential, new construction, remodel,or addition) SF
<br /> BUILDING TYPE: 0 SFR-DETACHED 0 SFR-ATTACHED 0 DUPLEX 0 MULTI-FAMILY-#OF UNITS: 0 COMMERCIAL
<br /> USE OF BUILDING:
<br /> ELECTRICAL APPLICATION INFORMATION
<br /> CONTRACT PRICE OF WORK: $ X00, w7
<br /> NUMBER OF DEVICES (if low voltage):
<br /> FIRE ALARM? 0 YES JQNu
<br /> ASSOCIATED BUILDING PERMIT#(if applicable):
<br /> DESCRIPTION OF WORK: rt Cc s 6-e— (�-e_.- 4-dr cf-2--
<br /> CONTACT INFORMATION
<br /> OWNER NAME: L t Cj t j,(pp(-// TENANT NAME(If Commercial):
<br /> OWNER MAILING ADDRESS: STREET ea 1 ( I (S 5(—
<br /> CITY Fkz-A- /, STATE ,^f ZIP q!1 C./- 1
<br /> OWNER PHONE: LS– 7670 /cttd' OWNER EMAIL:
<br /> CONTRACTOR NAME: I /A.O -L U C Gk-1 C.---
<br /> CONTRACTOR ADDRESS: STREET Q 1y4- j&-a_ 4E
<br /> CITY STATE LAA--- ZIP 67,126t-2-
<br /> CONTRACTOR
<br /> 72-CONTRACTOR PHONE: 4 d-C-r3''s--:�7sc;, CONTRACTOR EMAIL: (/t,,,t(a t(t,,ktiv. .e clic- ,t-, c P ci,—
<br /> CONTRACTOR LIC.#(REQUIRED): L//LOL- 7.-Y21- LAA-0 CITY OF EVERETT BUSINESS LIC.#(REQUIRED): � 1
<br /> TO
<br /> PRIMARY CONTACT: 0 OWNER CONTRACTOR ...,.,.�,�
<br /> R 0 OTHER(Please Specify)
<br /> CONTACT NAME: ' CONTACT PHONE: /-(3-�- S6 _ co 72�—
<br /> tAA( 1( L(vteti CONTACT EMAIL:
<br /> AGREEMENT: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 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 /> d7. (
<br /> PERMIT#
<br /> . /11 � E l (a0 ' 01 u
<br /> Owner/Authorized Agenlik ature Date (Revised 10/12/2015)
<br />
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