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<br /> 474"- LECTRICAL PERMIT AP LICATION
<br /> CITY OF EVERETT PERMIT SERVICES
<br /> 3200 CEDAR STREET, EVERETT, WA 9820142
<br /> /2-„ 4
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<br /> (P)425-257-8810 1 FAX 425-257-8857 1 (E)everetteps@everettwa.gov I www.everettwa,gov/permits
<br /> \ , PROJECT SITE INFORMATION
<br /> PROJECT ADDRESS:4, O , 5,0, (`{\t ,N', i.,J� t tR ,
<br /> BUILDING AREA(if residential,new construction,remodel,or addition)2-`'j t(' irl'tL\C�,\ SF
<br /> BUILDING TYPE: 0 SFR-DETACHED 0 SFR-ATTACHED bUPLEX 0 MULTI-FAMILY-#OF UNITS: 0 COMMERCIAL
<br /> USE OF BUILDING: e,e Y'7-4-1
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<br /> ELECTRICAL APPLICATION INFORMATION
<br /> CONTRACT PRICE OF WORK: $ 7 5 C
<br /> NUMBER OF DEVICES (if low voltage): Ij
<br /> FIRE ALARM? 0 YES AO
<br /> ASSOCIATED BUILDING PERMIT#(if applicable):
<br /> DESCRIPTION OF WORK: co-LA.C: l�'t ( {/1 s(�(.L 0,..,/-10,1 J`.fi,A,.c+E.A-4(e.c4'
<br /> i i-e-
<br /> �y CONTACT INFORMATION
<br /> OWNER NAME: �_11 CA/c j "k `U(``{� .ii.S 7L TENANT( NAME(If Commercial):
<br /> OWNER MAILING ADDRESS: STREET tom`, of / 31 A.-e l e,
<br /> CITY ��,..1/'C.,Y--t H-1 .,J STATE \Aj�A ZtP 9 E,)
<br /> OWNER PHONE:405- - 3E3.
<br /> _1 50113 OWNER EMAIL:
<br /> CONTRACTOR NAME: ('3 f'J JJ C'( ci.A(1 T !Jt-�v �...�i ; ) j'-,,.....c-Q
<br /> CONTRACTOR ADDRESS: STREET /(;)--' )S} .7L )4 -e (0 1
<br /> CITY?):1 1) 11 L'V r < S ii STATE V`„�,t4 ZIP 9t -)_ci, C
<br /> CONTRACTOR PHONE:3 _ C // - ( O CONTRACTOR EMAIL: 1 f
<br /> ,.�t.tt`lJ � 1 l �-/ _ t I/�,C7��J1t)(,0JPl-(itd/t;4 -v'1C:�,�C kA r�
<br /> CONTRACTOR LIC.#(REQUIRED):Aj St f SS 9/' 7 PC. CITY OF EVERETT BUSINESS LIC.#(REQUIRED): O 2-8 65
<br /> PRIMARY CONTACT: 0 OWNER 0 CONTRACTOR iirbTHER(Please Specify)
<br /> CONTACT NAME: CONTACT PHONE: 7(90 62 q/ - L� (`
<br /> CC1 k)' Ick tr�l`4 CONTACT EMAIL: i 1e s (c a `!O{V� o -V"c t,,‘ , , ,
<br /> AGREEMENT.-T hereby certify that I have read and examined this application and know the same to be true and correct. All provisions of laws and ordinances governing this 3I 2"
<br /> type of work will be completed whether specified herein or 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 I 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
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<br /> + , PERMIT#
<br /> fill jilf J 4 07/OwnerMi ' ed A ent Si na urer/ 2IJ
<br /> Date (Revised 10/12/2015)
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