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12/13/2016 TUE 9: 01 FAX 425 252 1666 CM Heating [0003/003 ELECTRICAL PERMIT APPLICATION CITY OF EVERETT PERMIT SERVICES 4L 3200 CEDAR STREET, EVERETT, WA 98201 (P) 425-257-8810 1 FAX 425-257-8857 1 (E) everetteps@everettwa.gov www.everettwa.gov/permits PROJECT ADDRESS; [� — BUILDING AREA(If residential, now constructlon, remodal, or addlHon) SF BUILDING TYPE: FR-DETACHED ❑ SFR-ATTACHED Q DUPLFX p MULTI-FAMILY-#OF UNITS; ❑ COMMERCIAL USE OF BUILDING: 8 va4 1 ?��f N��fo;'.��;�v�'[a:�1i'�•�,"i�l•i�;i•n ��t ..•Ir , '[`si,R", -;'" CONTRACT PRICE OF NUMBER OF DEVICES If low Volta e : FIRE ALARM? 0 YCE$ Q NO ASSOCIATED BUILDING PERMIT# If± IIrable DESCRIPTION OF WORK; OWNER NAME: TENANT NAME If Commerclal : OWNER MAILING ADDRESS; arReEr ` 2 'f"L— S' CIN STATE ZIP 2d OWNER PHONE: Wo M ILVO OWNER EMAIL: CONTRACTOR NAME; CONTRACTOR ADDRESS: aTRFET CITY STATE zIP CONTRACTOR PHONE; CONTRACTOR EMAIL: CONTRACTOR LIC,#REQUIRED : rr, y L. CITY OF EVERETT BUSINESS LIC.#(REQUIRED : O � PRIMARY CONTACT: ❑ OWNE*FR CONTRACTOR Q OTHER (Please Specify) CONTACT NAME; CONTACT PHONE; L, CONTACT EMAIL: AGREEMENT:Thereby certify that 1 have road and examined this epplicetlon and know the same to be iron and correct. Ail provisions of laws and ord;7ences governing this type or work will be cornpleted whether specified herein or not. The granting of a permit dogs not presume to give authoiliy to violate or cancel the provisions of any other state or local law regulatlnp cors"ctlon or the performan0e 01 Construction. That I ern authorized by the owner of this property to perform rho work for which appltcetion is made and i comply with the Siete Conlractcra Low 18.27 RCW and 296-top WAC. City of Eva-h Oflic/al U00 Only FEE PERMIT# Owner/Autharized Agent 91griature Dote (Revised 10/12/2015)