|
03/21/2016 MON 12: 23 Fax 4252521666 CM Heating ��03/003
<br /> �ECTRICAL PERMIT AI I LICATION
<br /> CITY OF EVERETT PERMIT SERVICES
<br /> �200 CEDAR STREET, EVERETT, WA 98201
<br /> (P)425-257-8910 � FAX 425-257-8857 � (E) everettopsQeverettwa.gov � www.everettwa.gov/permits
<br /> ����, ! "��; ,f�,'w4� `;:'�°r °�,��,�;�, ,,� .yr„ ;'� � . � -�•, ; .�ROJECT SITE;INFO�Mi4T10I� " " � '
<br /> s, R,r n, .,�, ,E �
<br /> PROJeCT ADDRE9$; + �� � �
<br /> BUILDING AREA If rosldentfal, new canslructlon, remodel, or addlllon) 3F
<br /> BUILDIN(3 TYPE: ❑ SFR-DETACH�D SFR-ATTACHED ❑ DUPL�X ❑ MULTI-FAMILY-�i OF UNIT8: ❑ COMMERCIAL
<br /> US�OF�UI�DINO:
<br /> :�i�,;�;r�Y,'�`,:;;� �' �,�;,';��,i `'{",'V'.s:,':j'�:°� `�` " b,•::,.�,,�'. LEGTR�CA�;,�►,pP41CA1"IOI!M,II�.�C�RMA710�; ' ' . � ',
<br /> CON7RAC7 pRICE OF WORK; $
<br /> NUMBER OF DEVICES If low valta e :
<br /> FIRE ALAf2M7 ❑YE5 ❑ NO
<br /> AS80CIATED BUILDING PERMIT# if a Ilcable :
<br /> DESCRIPTION OF WORK:
<br /> �- � �`�i p�' t � � �.
<br /> ���� ' '(,�` �,l',,., ;.�.,,7.:, �; :�,�. , ���. � ,CON�'�CY INi�OI�N1dTIOPM� ' � �
<br /> •;;i�` .i.,';:�. •;_; , ,,r, . ,
<br /> OWNER NAM�: � TENANT NAME IF Commerclel :
<br /> OWNER MAILIN(3 ADDRE88: s�reeer ��D �,
<br /> C� 9TATE V V ZIP � \
<br /> OWNER PHONE: ��' OWNER EMAIL:
<br /> CbNTRACTOR NAMEr '
<br /> CONTi�ACT012 AUdR�S3� BTREET �
<br /> C�T�" � 9TATE ZIP ZJ' 1
<br /> CONTRACTOR PHONE: � Qs�j� CONTRACTOR EMAIL: r I ll� � r �
<br /> CONTI�AC'fOR LIC.�!RECiUIRED : � ~I � CITY OF @VERETT BUSINESS LIC,#(REQUIRED): D'7. (>
<br /> PRIMARY CONTACT: ❑ OWNER CONTRACTOR Q 0'�HER(Plaase Spacify)
<br /> CONTAC NAM�; CONTACT PHONE: (;i
<br /> �I� ��, �l� CONTACT EMAIL:
<br /> ,
<br /> AOREEMENT:T hereby c�rtlty thet 1 have read end exeminad lhla eppflceflvn and Imow fha sama to 6a frue and correcL Af�prnvlslona of�aws e rdfiencas governfng thls
<br /> type ol work w!!1 be oomplBfed whether ypac/hed hera�n or not. Tha granting o(e permlf do�s not presume fo qlve c�uthorNy to vlolete a aanoel lhs p�ovlslons o/eny othar s!e(a or
<br /> locef law r'eguf9ling ConstrucNoR or the pBrform9nce ot conslrucflon. That f am euthorlt6d by tAe ownar of thla property to pe�form fhe work(or wnlch epplrcation is mede and!
<br /> comply wrth fhe 5tate Contraator�Law 98.27 RCW entl 296.20p WAC.
<br /> Cl1y ol�vererr 0111crel use Only
<br /> FEE
<br /> ��� ,�c',
<br /> PERMIT#
<br /> � a�l l� E ��'��� I`2��
<br /> Ownar/Authorizad Agaqt SIgh9 Ure D�te (Rovlsed 10/92/2016)
<br />
|