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ELECTRICAL PERMIT APPLICATION
<br /> '111//444‘V/7:a CITY OF EVERETT PERMIT SERVICES
<br /> vidg.2 1.-
<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 /> IPROJECT SITE INFORMATION
<br /> PROJECT ADDRESS: 3727 R,,k,c,Ler A J e,.., r-,. Li ei,4-1- t,k,1,4 7 „.2 C.))
<br /> BUILDING AREA(if residential,new construction, remodel,or addition) /COO SF
<br /> BUILDING TYPE: 0 SFR-DETACHED 0 SFR-ATTACHED 0 DUPLEX 0 MULTI-FAMILY-#OF UNI' : OS COMMERCIAL
<br /> USE OF BUILDING: Ai At(0... ( I '4
<br /> ELECTRICAL APPLICATION INFORMA ' ON
<br /> CONTRACT PRICE OF WORK: $ /6/7')0
<br /> NUMBER OF DEVICES (if low voltage):
<br /> FIRE ALARM? 0 YES 13,140
<br /> ASSOCIATED BUILDING PERMIT# (if appli -
<br /> DESCRIPTION OF WORK: 1,0e..... afe, +6..,i)cd,+'ik , Pe. Zr,0.-ko 1 tA,i 1-ii 1 4(
<br /> a \e :4,.: 7
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<br /> 0 TACT INFORMATION
<br /> OWNER NAME: 4; -a TENANT NAME(If Commercial):
<br /> ( 1-.."
<br /> OWNER MAILING ADDRESS: STREET 5 e( **:' r\u_z,k.er 4 )e-
<br /> CITY r ,( 4+ STATE 10 4 l'P Clg20 1
<br /> OWNER PHONE: ,OWNER EMAIL:
<br /> CONTRACTOR NAME: E: ( (..,.;,
<br /> CONTRACTOR ADDRESS: s EET C.--4' /2 c,,,,j A I 44,‘ 3-1.
<br /> CITY k if v V4*--- STATE it)A zi, ci' cr.3.,),_
<br /> CONTRACTOR PHONE: 5 ';"- 2 1 4-8-4/9.4/ CONTRACTOR EMAIL: e_ L-1•11.e.17'. .r...,..,-is0 e - 4.: -CO 6,0 tesi
<br /> CONTRACTOR LIG.#(REQ RED): Z . 44 Ll lit 4 CITY OF EVERETT BUSINESS LIC.#(REQUIRED):
<br /> PRIMARY CONTACT: • OWNER12 E.CONTRACTOR 0 OTHER(Please Specify)
<br /> CONTACT NAME: CONTACT PHONE: 5L//_ c2 1 /-/-5/Ligii
<br /> EMAIL:
<br /> CONTACT ' r
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<br /> AGREEMENT:I hereby certify that I have read and examined this application and know the same to be true and correct. Al)provisio4 of laws and ordinances governing this type
<br /> of work will be completed whether specified herein or not. The granting of a permit does not presume to give authonty 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 Orgy
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<br /> PERMIT#
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<br /> 0/ ..< „,,, _ i7/7S/// 7 Et -7 (004
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<br /> Owner/Au rizeil Agent Signature Date (Revised 9/2312016)
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