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G3/21/2U17 08: G1 3604740126 DCNNELSON ELECTRIr ?,*,1C #3789 P. OU1 /UU1
<br /> �LECTRlCAL PERM[T APF'LICATION
<br /> CITY OF EVE=RETT PERMtT SERV�CES
<br /> 3200 CEDAR S'rREET, EVERETT, WA 98201
<br /> (P)425-257-8810 [ FAX 425-257-8857 E (E) everetteps@everettwa.gov� www.everetfwa.gov/permits
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<br /> PROJEGT ADDRESS: `�Z� �'C��S 1 � I��P� i"��• �� ��
<br /> 8�11LDING AREA(if residential, new construction, remodel,or addition}_ SF
<br /> BUILD]NG TYPE� ❑ SFR-DETACHED A SFR-ATTACHED ❑ DUPLE:X ❑MULTI-FAMILY-#OF UNITS: ❑COMMERCIAL
<br /> USE OF BUILDING� �;,��
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<br /> CONTRACT PRICE OF WORK: $ , �,1'� °'
<br /> iVE1M8ER OF DEVICES if low voltaqe :
<br /> FlRE ALARM? ❑YES ❑ NO
<br /> ASSOCIATED BUILDING PERMIT#(if appliCabla : �
<br /> DESCRIPTION OF WORK: Qe C9✓y.�G'}�' fiJ P�qT I��
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<br /> owNER NAME: h�1��%;� �tir�S T�NArJT NAME lf Commercial :
<br /> OWNER MAlL1NG ADDRESS: srRE�r �Z g C e.CXS �
<br /> cm 21/�r'e7� STATE �✓F� zaP�c�Z a 3
<br /> OWNER.PHONE� d'/�-3 I�'�L13� � OWNER EMAlL:
<br /> ...... . ....................................
<br /> . CONTRACTOR NAME_ DQy�� / ,�,.J e �.C`�Yt c
<br /> CON'fRAGTORADDRESS: snzEsr �,3G1 /V �J� �'� U{ '
<br /> CIP' ¢'� STAre IW�. yp /��Z l
<br /> C�NTRACTOR PHONE:�I L�.S 'Z..j -`�7�% CONTRACTOR EMAI I.:
<br /> CONTFZqCTOl2 L1C-#(REQUIRED): +�Odl,dl,7�e.,fl yr.{�z CITY QF EVERETT BUS[NESS LIC.�{REC2UIR�D):JJ� �,,3
<br /> _ ....... . ..... ......_ ........ .
<br /> PRIMARY CONTACT: �OWNER �GONTRACTOR �OTHER(Please Specify)
<br /> �ON7ACT NAME: COAITACT PHONE:��s��? _.�`� �
<br /> �C'�/ f � . I���� CO[�TACT EMA1L:�}J-,kli�.P.��� ,.G'.j�°.C�S':C Cra �d�✓' C°��+
<br /> AGREEMENT-/hereby ce�tify fhst!he�read and examined fhis sppli�ation 9nd know�he seme ir�ba true end correcf. A!I provisiona oflativs and ordinances govmming fhis type
<br /> of work wil!b�complQfsd whether spacrfigd hBrein or noL The grentinq of a permit doss nof p�sums to give authoriry to violat�or cancs!fh�pmvisions of any othsr stafc or
<br /> loca!law regulating constarctipn or fhe pe�ormsnCe of conslrucl-+'pn. That 1 gm autho�iz6d by the owner of this property fo pe�form the v✓oric fur which applrcafion is mada and!
<br /> comply with the Stsfe Contra�OrS LsW T8.27 P,CW anp'�6.200 WAC.
<br /> /_., /��/
<br /> Gity of EvsrstY Officia!U5G ORty
<br /> -, PERMIT#�
<br /> -� �- :� zz. , E —� � — � c��
<br /> rlAuiholzOC!\qeM Signature Date (R9viSBd 9/23/20'16)
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