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1U/24/2015 15:31 35G47401L5 DGNNELSON ELECTR.IC INC #372i P.OG2 /CiC��
<br /> ELECTRICAL P�RMIT APPLICATION
<br /> CfTY OF EVERETT P�RM1T SERVlCES
<br /> 3200 CEDAR STREET, EVERETT, WA 9820'l
<br /> (P)425-257-8�10 � FAX 42�257-8857 � (E)everetteps@ever�tfwa.gov� www_everettwa.gov/permits
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<br /> PROJECTADDI2ESS= 6�OS : L1 � R ev�'�'� c,.A_
<br /> BUIE.,pING AREA(if residential,ngw Construction, remodel,or addition) SF
<br /> BUIl.DING TYPE: I�'SFR-DETACFiED �SFR-ATTACHED O DUPLEX 0 MULTI-FAMILY-#OF UNITS: 0 COMMERGIAL
<br /> U5E OF 6LlILDING_ �Q
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<br /> CONTRACT PRJCE�F WORK: $ ��j'p0�
<br /> NUMSER OF DEVICES if Eow vofta e):
<br /> F[RE ALARM? ❑YES L�NO
<br /> ASSOCIATED BUILDING PERMIT# if a licabie)_
<br /> DESCRlPTION OF WORK: /✓@�./ (.�5�
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<br /> OWNER NAfNE: �C«,.� jj �'u Gl TENANT NAME(If Commerc�al):
<br /> OWHFR MAlLING ADDRESS: sTREsr �D O� jZ�/
<br /> GT' /�1 `'` C STATE 'I � Z1F lOZ7O
<br /> OWNER PHONE:�Z�S" �— �S'j OWN�F2 EMAIL:
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<br /> coN�r�c�oR Hana�:�a /Son E'I�P 7�r •
<br /> CONTRACTOR ADDRESS: srReEr �l /1/ QJ M �'� /J�,{
<br /> CfTY �f•)yI /Q✓1 8TATE �A 77P /O ZZ3
<br /> CpNTRACTOR PHONE CON[TRACTOR EMAIL: O�r�1Q/sp,�, Ie ,' ,' ,C o•�
<br /> coNT�xacroR L�C_#(RE�u�REo�:a pn»�e O VaI� CITY OF EVERETT BUSINESS LlC.#(FEQUIRED)�a,3!'� g�7
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<br /> � PR[�qRY CONTACT_ ❑OWNER I�CONTRACTOft ❑OTHER(Please Specify}
<br /> CONTACT NAME: CONTACT PHONE: C�/Z�Z3 ,Y7��
<br /> S���T" �e TGf'lrrs .� coNT,ncr E�r,v�: o n an. l � r�o..fi�er;e o,�.
<br /> AGREEMENT.�!hereby ce�tity ih9t!h�ve/sad and examirred this applicsiion 3nd know if18 SBme to fiC trus and correct. A!1 provis�ons of i�wS entl ordinancss govsrning rhis type
<br /> �f wprk wi!!bs completad whefher SpeC+Yi�d hcrcin or not. Ths granGng of a pemrlt tl0es nOf p�SUme t0 give aufhoiity to violate or CanCe1 tAe prpVis/ons o�any oPhcr state or
<br /> �oCe/l8W rsgu/aEng construc&on or th�p�Hamance of consfruc£ion. Thsf l am 9ulhorized Ay tHC ow�7cr of this property to perfo�m;he urork t�r which app7ication is mado and I
<br /> Comply wiih the State Contractors LSw 18.27 RCW and 29�.200 lA/AC.
<br /> Ciiy of�verett Off/cial Use Only
<br /> PERMIT#
<br /> ,�/z�e� E ��cn -- I�g
<br /> Owner/Au=h01'iYsd Ag'o11t Siynature Date (RBvised 9/Z3/2098)
<br /> �6
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