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12/01/2016 THU 8: 30 FAX 425 252 1666 CM Heating 0003/003
<br /> 04' ELECTRICAL PERMIT APPLICATION
<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,averettwa.gov/permits
<br /> ,'':.,lir; I, • •JEC'1'-mit 1pJFQRMA'f` b
<br /> PROJECT ADDRESS: 1 2...'Ap ST Ouse Se___,
<br /> BUILDING AREA(If resIdentlel, new construction, remodel, or addition) SF
<br /> BUILDING TYPE; R-DETACHED 0 SFR-ATTACHED ❑ DUPLEX 0 MULTI-FAMILY•#OF UNITS: 0 COMMERCIAL
<br /> USE OF BUILDING:
<br /> ,.S{Ih,,','2 :-?:"1:+Cii;c, '%y1I i,4; "`'•�•��'�{tir.y0 10,47� S'`� ,{TI11 la 'L ; Rig.Tr.( t ! ''''I': .
<br /> CONTRACT PRICE OF WORK: $
<br /> NUMBER OF DEVICES (If low voltage): I
<br /> FIRE ALARM? 0 YES ❑ NO
<br /> ASSOCIATED BUILDING PERMIT# If as•Ilcable :
<br /> DESCR - ION OF WORK:
<br /> /AI. 4,_ - 4- T fkl QJL I y- 1 rC-�F's .p.
<br /> ,--,..7—. .,,. . ,.;,;.,- 7,,,a.,,,,,,,r,,,,-,.. ., ,,::,:777=„H_., ,,,; 0,.. ,,, ,, , , _ ."‘,.. , , y : , _..____,,. , „ ,/, , ,4 , , , • -- - , ---
<br /> OWNER NAME: T14-Thja c) j TEiNANT NAME If Commeral:'I
<br /> OWNER MAILING ADDRESS: BTREET 12 CCI 2 (�S•'r -e
<br /> m` STATE V v ZIP `.7 CO
<br /> OWNER PHONE: . —r a C6 • 2G t OWNER EMAIL
<br /> CONTRACTOR NAME: '
<br /> CONTRACTOR ADDRESS: STRUT `"l ` •C1�,r {
<br /> CIN ��l e'_ STATE 1...,.0 LIP qqalD,
<br /> CONTRACTOR PHONE: 62SA. Q CONTRACTOR EMAIL: 19
<br /> CONTRACTOR LIC.#REQUIRED t Ji 111C. _;,_, 1/447r),5 O. CITY OF EVERETT BUSINESS LIC,#REQUIRED': I 0 9 •
<br /> PRIMARY CONTACT: 0 OWNER o CONTRACTOR ❑ OTHER(Please Specify)
<br /> CONTACT -
<br /> IN�AM'E::�, CONTACT PHONE: '—i�,�`. us z
<br /> I `Q.J2- C�Th CONTACT EMAIL: �JCC''�� `, � + iri nTh
<br /> AGREEMENT' T hereby car*Chet/have read and examined this application end know the same to be true end correct. Ail provisions Of lbws end Ord?4,06.9 governing this
<br /> type of work will be completed wharhar 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 ern authorized by the owner of lids property to perform the work for which application is made end I
<br /> comply with the State Contractors Law 18.27 RCVV and 28e.200 WAC,
<br /> City of Everett Official Use Only
<br /> ' F E
<br /> ' q___ ,--------
<br /> l PERMIT# _
<br /> / , ' 17. I ) tP E Ro( 2 --DC Z
<br /> Owner/Authorized Agent Signature Date (Revised 1W12/2615)
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