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<br /> ELECTRICAL PERMIT APPLICATION
<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 INFORMATION `-•,
<br /> PROJECT ADDRESS: 0 „L-�{-v'�c? E t 0
<br /> BUILDING AREA(if residential,new construction,remodel,or addition) '(\ X I t S 00
<br /> BUILDING TYPE: 0 SFR-DETACHED g„SFR-ATTACHED 0 DUPLEX 0 MULTI-FAMILY- OF U _ 0 COMMERCIAL
<br /> USE OF BUILDING: 1.-"‹.„3":1( -'\,- 't a-12
<br /> ELECTRICAL APPLICATION INFORMATION
<br /> CONTRACT PRICE OF WORK:$ `) .b3 .,
<br /> NUMBER OF DEVICES(if low voltage):
<br /> FIRE ALARM? 0 YES A NO
<br /> ASSOCIATED BUILDING PERMIT#(if applicable): t .L ig ' lq
<br /> DESCRIPTION OF WORK: a J 7_c)c �:. ncit() `* (-1/t cx._ -- 1. 4 ,t ,t,(j,
<br /> CONTACT INFORMATION
<br /> OWNER NAME: "' —Y‹, 1C t'' Qilr '. &5*\(`(‘.. TENANT NAME Of Commercial):
<br /> OWNER MAILING ADDRESS: STREET QC)\i Uk) ore- 1:Vvt 6` ,
<br /> CfTV �yf" -`L (� STATE V�.li
<br /> ZIP q
<br /> OWNER PHONE: '"12 - 5 70 ._��0 t OWNER EMAIL: _3_"o..c&..s—��Y�".t���(,'t` Yl .f jv\i,stA..�,, ('` fyst
<br /> CONTRACTOR NAME: ! - y J C CkS.�V 1...i -TCC_,
<br /> CONTRACTOR ADDRESS: STREET .5%L; S,�,r five,,. se
<br /> CITY 5 vva,,i, \ltAA,Ski STATE 1,0 49 ZIP et 24 0
<br /> CONTRACTOR PHONE: 4z5 ..3 _ 7O(.....-1-70:k CONTRACTOR EMAIL: C ,,l C-.ksz,,t'1.— .l..T,t I IceFFFF ` .....,, jl!
<br /> CONTRACTOR LIC.#(REQUIRED):b tor,S,6iF",'Z fps j rvi + CITY OF EVERETT BUSINESS LIC.#(REQuMREt. : I j C,c,c",:77
<br /> PRIMARY CONTACT: 0 OWNER 0 CONTRACTOR 0 OTHER(Please Specify)
<br /> CONTACT NAME: CONTACT PHONE: 42,5-3 I,7°,-7'7 02
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<br /> l x+ (4 CONTACT EMAIL: C.k _e_k C ti 1c.7:4011, a • (,)",�
<br /> AGREEMENT'I hereby certify that t have read and examined this application and know the same to be true and correct. All provisions of laws anes governing this type
<br /> of work will be completed whether specified herein or not. The granting of a permit does not presume to give au to violate or cancel the provisions of any other state or
<br /> local law regulating construction or the performance of construction. That f am authorized by the owner of this proper a perform the work for which application is made and l
<br /> r comply with the State Contractors Law 18.27 ROW and 296.200 WAC.
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<br /> City of Everett Official Use Only
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<br /> PERMIT#, Epo ( - s '�
<br /> Owt{er/Auih0 dd Agent Signature Date (Revised 923/2016)
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