|
03/25/2016 FRI 17: 24 FAX 4252521666 CM Heating 0003/003
<br /> ELECTRICAL PERMIT APPLICATION
<br /> CITY OF EVERETT PERMIT SERVICES
<br /> 3200 CEDAR STREET, EVERETT, WA 98201
<br /> (P)425-257-8810 FAX 425-257-8857 1 (E) everetteps c@everettwa,gov www.everettwa.gov/pormlts
<br /> ! "Ifi � i7 9 t r ( s-'�•r'g,�, .M'' r^ vi. t y!n:9.fi' V `+�( I<
<br /> ��� i � w,J t�'fi�'�r'f�,' .+� K9L r �(,' )��^. U�1�Tt �Jp�1�i.i„,,JiS,� �r t• 1. ��'��4 i`Y
<br /> tf.�,t''fir° .�Y.ih:•��.�,��c,� � t,�. ,� v�y; m� M K� ! � I�Pefi 91 �� -f I'�1;�ld;”"fl w;�, r���d�f><ZSi+���y��;,sti��� f„S.� ,h
<br /> b h:,�,�i,,, r,M^n�,lka�, .!fi�.�',)�.a?•,d rt •s�a =,f m .r� ,.r.,F', xn„o,. r)h,a a.�.n,.!..,$,^ «,.u',1',�� I';„� i),I I, fi ! ,.n
<br /> PROJECT ADDRESS:
<br /> BUILDING AREA(if residential, new conetruc n, remodel, or addition) SF
<br /> BUILDING TYPE: ❑ SFR-DETACHED FR-ATTACHED ❑ DUPLEX ❑ MULTI-FAMILY-#OF UNITS: ❑ COMMERCIAL
<br /> USE OF BUILDING:
<br /> ;7.1
<br /> iNEv`�d +i.l• °��FM15�1T�im.Jt. daix� ? "k4�R, r��M1k7
<br /> h "�d � :���?” i� ,, , t fl ��„� °� .�• ,�Q��� ,•�7t?�.rira��h' h.r!^r
<br /> CONTRACT PRICE OF WORK; $ b
<br /> NUMBER OF DEVICES if low voltage):
<br /> FIRE ALARM? El YES d NO
<br /> ASSOCIATED BUILDING PERMIT# If a Ilcable
<br /> DESCRIPTION OF WORK;
<br /> +;',.,hl•�'i.;r ,f�.T ..:4 WI d"i<��`�'F^�'y:•1..,'�i;A'p.y."'rr:q •.7-., l ,�.,,,.., :.r,;,. ,r, 1 ,, ,,9,, !..
<br /> ,`. r,,r}� �•y.,,"1,J,.�r��..r.,'t�Ff 1 t 6�1,). rl%' Si ,,,,9��11�/1,:,/�'nsi 7' a���'11s�SSn�d,kk�7.tii'�Itl;nr.•
<br /> S, .,i, ,r .•� .r r d'tn i6.,'.tr. l,,;f,,r� ,�,,.S,�J r t ) r,., I Q r 'l,,,yrr .1� <;�. (1,
<br /> OWNER NAME: TENANT NAME If Commercial):
<br /> OWNER MAILING A RESS; STREET 3
<br /> OITY VATE ZIP
<br /> OWNER PHONE: OWNPR EMAIL:
<br /> CONTRACTOR NAME;
<br /> CONTRACTOR ADDRESS: STREET LO
<br /> CITY STATE ZIP V
<br /> CONTRACTOR PHONE: q2L 2 CONTRACTOR EMAIL: /J ,
<br /> CONTRACTOR LIC,#REQUIRED ; �`� - l� CITY OF EVERETT BUSINESS LIC,#(REQUIRED):
<br /> .. _ .
<br /> PRIMARY CONTACT: ❑ OWNER TRACTOR ❑OTHER (Plenoe Specify)
<br /> CONTACT N ME. CONTACT PHONE: 't
<br /> 1
<br /> 1 ` � �e 'n
<br /> CONTACT EMAIL:
<br /> AGREEM[_NT:T hereby certify that I have read and oxamined this application and know the same to bu true and correct. All prvv/alons of laws and ordinance verning this
<br /> type of work will be completed whether apeclR®d haraln or not, The granting of a pormlt does not prosum®to give authority to violate or cancel the prov/slons of any other state or
<br /> local laW regulating consfruCtian or the performance of construct/on. That t am authorized by the owner ofthfa prOperty ro parform the work for which application Is mads and I
<br /> cornply with the State Contractors Law 18.27 RCW and 288.200 WAC.
<br /> City of Evoreh'Official Usa Only
<br /> FEE
<br /> .713 -
<br /> PERMIT#
<br /> E ICS 3 - 17 3
<br /> wner/Author zed A i't S1 nature Data (Ravlsed 10112/2015)
<br />
|