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<br /> ELECTRICAL PERMIT APIPLICATION
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<br /> CITY OF EVERETT PERMIT SERVICES
<br /> - 3200 CEDAR STREET, EVERETT, WA 98201
<br /> (P)425-257-8810 I FAX 425-257-8857 I (E)everetteps@everettwa.gov I www.everettwa.gov/permits
<br /> PROJECT SITE IIMF*RIVIATIONI
<br /> I
<br /> PROJECT ADDRESS: Z,72.2... t-4 imA ,et,v10) A1-14-, • 1
<br /> BUILDING AREA(if residential,new construction,remodel, or addition) 1 6 0-0 SF
<br /> BUILDING TYPE: 0 SFR-DETACHED -2:6F11---A ACHED 0 DUPLEX 0 MULTI-FAMILY-#OF UNITS: 0 COMMERCIAL
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<br /> USE OF BUILDING: e,,,,,Dk /4_44, i.di ,
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<br /> ELECTRIC 1-,L APPLICATIOM INIFORili)ATIOM
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<br /> CONTRACT PRICE OF WORK: $ 4SA , L
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<br /> NUMBER OF DEVICES(if low voltage):
<br /> FIREALARM? EYES CI NO
<br /> ASSOCIATED BUILDING PERMIT#(if applicable):
<br /> DESCRIPTION OF WORK: CLA lccd),(3z-e-- rfit....4.,,,,LkOLL- c--tc- et-t--t-\Am-e- ( *-t
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<br /> CONTAdT'INFORMATION
<br /> . . .
<br /> OWNER NAME: Di—LAAV-- 6.-- t-t-L-COLA...V.AL9 TENANT NAME(If Commercial):
<br /> OWNER MAILING ADDRESS: STREET
<br /> cny STATE ZIP
<br /> OWNER PHONE:(4?c)3.4q -603 p OWNER EMAIL:
<br /> CONTRACTOR NAME: 6a6-04 EtA.,...—e,,,(34./( (..-/---C-
<br /> CONTRACTOR ADDRESS: STREET /I 2 Ft)7 fie....,,,i f/2
<br /> CITY err.,ZErLe - STATE (e_-)/A ZIP
<br /> CONTRACTOR PHONE.(424-) "72c.- 1CONTRACTOR EMAIL: {-(0,16,1,Zain,-,-LA-4,-(v,. . , 6•
<br /> CONTRACTOR LIC.NREQUIRED): NtF-V cat- 4 IcY_
<br /> CITY OF EVERETT BUSINESS LIC.#(REe IRED):
<br /> PRIMARY CONTACTER 0 CONTRACTOR 0 OTHER(Please Specify)
<br /> CONTACT NAME: CONTACT PHONEc4 ") 343 - God t
<br /> in.) CONTACT EMAIL:
<br /> AGREEMENT:Thereby certify that I have read and examin d this application and know the same to be true and correct All provisions of laws and ordinances governing this
<br /> type of work will be completed whether specified here' not The granting of a permit does not presume to give authority to violate or cancel the provisions of any other state or
<br /> local law regulating construction or the performance of construction. That!am authorized by the owner of this property to perform the work for which application is made and I
<br /> comply with the State Contractors Law 18.27 RCW and 296.200 WAC.
<br /> City of Everett Official Use Only
<br /> —FEE
<br /> . (00 ------
<br /> PERMIT#
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<br /> 1
<br /> OwnerlAuthorized Agent Signature Date (Revised 10/12/2015)
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