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05/19/2016 THU 9: 50 FAX 425 252 1666 CM Heating fO03/004
<br /> ELECTRICAL PERMIT AI4LICATION
<br /> CITY OF EVERETT PERMIT SERVICES
<br /> 3200 CEDAR STREET, EVERETT, WA 98201
<br /> 1� (P)425-257-8810 I FAX 425-257-8857 I (E) everetteps@everettwa.gov www.everettwa,gov/permits
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<br /> i'�{. l .c`n i A� '7T + `' M1 N'�i•'1;��; i, J�l. M1,li�, ,1
<br /> PROJECT ADDRESS; a ct lig vi'
<br /> BUILDING AREA(If residential, new construction. remodel or addition) SF
<br /> BUILDING TYPE: CI SFR-DETACHED SFR-ATTACHED 0 DUPLEX 0 MULTI-FAMILY-#OF UNITS; 0 COMMERCIAL
<br /> USE
<br /> 1 OF BUILDING:
<br /> •
<br /> �'Y�w'li"'a`�'l .ag'�'•{';�}y�ll'i�ti.ii�,5�}`/•�'l�� ihi�ptl,lj����,r(��, r p/+'�R ,61'z' y T �]N /�� `/� .;Irl -,� t., •� �
<br /> +,e1, 21 ';r�A''�� ;�51,•,,tfln�P'�. kli)r r�,S 1�` rV vrf, �Y�tioegotR!c4044rPLIQ4'*•�T'�(';I �, ,0* ��IKN! d�,�,+�t fir- t `
<br /> S� ,.� o, � , �k -„ � •iP.;�„r „JL.)4, t '. •r
<br /> CONTRACT PRICE OF WORK: $ ,
<br /> NUMBER OF DEVICES (If low voltage):
<br /> FIRE ALARM? ❑YES ❑ NO
<br /> ASSOCIATED BUILDING PERMIT#(If applicable):
<br /> DESCRIPTION OF WORK: ,L - 1L L4.0f10F55 kQ Ar p r
<br /> 'CONTACT'INFORMATIbN x.';..
<br /> OWNER NAME: 1\f/L. a... voL,LLEAP, TENANTNA (Ifommorclel);
<br /> OWNER MAILING ADDRESS: sTREaT 1 L' 1 q'f1A S r ^
<br /> CITYeTATE Y zir (
<br /> OWNER PHONE: 3i ( �( (05-9-- _ OWNER EMAIL:
<br /> t l
<br /> CONTRACTOR NAME: ( Y1O O -i( ^
<br /> CONTRACTOR AbDRESS: STREET C r_J ^
<br /> CITY STATE 21P Cf V� I
<br /> CONTRACTOR PHONE; ((( jam CONTRACTOR
<br /> CONTRACTOR LIC.#(REQUIRED): Ikoy KyiL `ra CITY OF EVERETT BUSINESS LIC.#REQUIRED):` le 0
<br /> PRIMARY CONTACT; 0 OWNER ONTRACTOR CI OTHER(Please Specify)
<br /> CO T T NAME: - CONTACT PHONE; LQ5 ;; G
<br /> 4 ! I ' Y ► CONTACT EMAIL: }1/ ` _`
<br /> lc-t 12.)C,tivihZatCL�Y1/1
<br /> AGREEMENT:T hereby cettlfy that I have react and examined this application and know the same to be true and correct. All provisions of laws and old, Aces 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 290.200 WAC.
<br /> Oily of Evorett Official Use Only
<br /> FEE-
<br /> / PERMIT#
<br /> 6— q fie E ,api ) I11 '?)
<br /> OwnerlAuthorlxed Agent 8lgnaturoI
<br /> Dale (Revised 90112/2016)
<br /> 1
<br />
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