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11/10/2016 THU 15: 317 FAX 425 252 1666 CM Heating f�J00'z/002 <br /> ELICTRICAL PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> (F') 425-257-8810 1 FAX 425-257-8857 1 (F) everetteps c@Deverettwa.gov I www.everettwa.gov/permits <br /> 0. , <br /> PROJECT ADDRESS,, I O <br /> BUILDING AREA(If residential, new construction, remodel, or eddltloh) SF <br /> BUILDING TYPE;49SFR-DETACHED ❑ SFR-ATTACHED M DUPLEX ❑ MULTI-FAMILY-#OF UNITS; ❑ COMMERCIAL <br /> USE OP BUILDING; <br /> _it'rtYrCIO <br /> wi 4 Y �1. it Jr. .,'' '=ir''i•\57;':u.'{r' <br /> CONTRACT PRICE OF WORK: $ <br /> NUMBER OF DEVICES if fow voltage): <br /> FIRE ALARM? d YES Q NO <br /> ASSOCIATED BUILDING PERMIT# If a Ilcable , 'Ekv _0216 <br /> DESCRIPTION OF WORK: <br /> anbI MCT W©V' 1/2- 1 <br /> Q D 1 <br /> .h,,.ir" sig <br /> '` ,sir r. 1 7' ;•I, .r4'^ <br /> OWNER NAME! N`3 TENANT NAME It Commorclal : <br /> OWNER MAILING ADDRESS: 1 c <br /> �TRt:ET <br /> CITY eTATe ZIP <br /> OWNER PHONE: c�.5o`2 OWNER EMAIL: <br /> CONTRACTOR NAME: <br /> CONTRACTOR ADDRESS: STREET <br /> rA <br /> CITY _ STATE <br /> CONTRACTOR PHONE; -"�p� CONTRACTOR EMAIL: <br /> CONTRACTOR LIC.#REQUIRED : CITY OF EVERETT BUSINESS LIC,#(REgUIRE6 :, <br /> PRIMARY CONTACT: ❑OWNER CONTRACTOR OTHER(Please Speoify) <br /> CONTACT NAME; CONTACT PHONE: --aD <br /> CONTACT EMAIL: VYU � . <br /> AGREEME147.,T hereby certify that I have read and examined(his applicatlen and know the same to be true and correct. All provlslans of laws and and aces governing this <br /> type of work will be compisteo'whether specified herein or not. The granting ora permit dose not presume to give authority to violate or cancel the provisionsofany other stale or <br /> local law regulefing construction or the performance ofconstruotlon. That I am atifhorized by the owner of thts property to perform the work for which appllca6on Is mads and f <br /> comply with the State Contractors Lew 713.27 RCW and 299.200 WAC. <br /> olty of Everett official use only <br /> F <br /> _6 <br /> 4'2/�5 <br /> ©0 <br /> � PERMIT# <br /> Cwner/Authorized Agent Signature Date (Revised 90192/2016) <br />