|
09/10/2016 SAT 9: 35 FAX 425 252 1666 CM Heating i 003/003
<br /> EECTRICAL PERMIT APRICATION
<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 www.everettwa,gav/permits
<br /> a`:.�`�u'�f).�,c:a'�r,''iJ:Sib�+ atr�,�x;t°�,.f.. .4;,:-•i.��p���,aviy� ;';�:�,, _:,5�p � �T'�` �t �. �`Ap� }� y •
<br /> •
<br /> ,L•La l.,I•,4 a�,a�f,. �t�✓�rir.,> , ':i: .•�, ::�, ., '�'r•`,., t7 ,1111'-.�n.R .,7•, r ."'oZ'!�T'!!�,�: �R,�, ,; .
<br /> PROJECT ADDRESS: _ `.("I aa- 10Cit n
<br /> BUILDING AREA(If residential,new construction, remodel,or addition) SF
<br /> BUILDING TYPE: 0 SFR-DETACHED ❑ SFR-ATTACHED ❑ DUPLEX ❑MULTI-FAMILY-#OF UNITS: ❑COMMERCIAL
<br /> USE OP BUILDING:
<br /> •
<br /> >V tk'.(Y+4+r"SyLtl.i��r..i�.,'.�Y y�e�1 "� � y�y�•�e �v ., rF1''T'n� ,n.„�.. �
<br /> 0"��4, i',,s i.���,..1l,',�,y`�/10Ntl ,•f u Y - Y1 Y;,. t,�,,��a: ..
<br /> u< 't:FfdFH.'- �t . ..�. i�t'»l;l .,1 tl T 1' LNI.•' � J, f ` li3lj,��S`�.,Sd i,�A'h4{'i�l,. r
<br /> CONTRACT PRICE OF WORK: $
<br /> NUMBER OF DEVICES (If low voltage): I
<br /> FIRE ALARM? 0 YES 0 NO
<br /> ASSOCIATED BUILDING PERMIT#(If applicable):
<br /> DESCRIPTION OF WORK:
<br /> • - 4 Cs� �� G�~R t C, � �s'Y-�t�x + vh 55red), `�'�a-RSYti4
<br /> to 03,PloijiL k.0 1—Y1
<br /> " •.f7..."£riF',r!1���, . 9 ,,: .P,1/4 . au, r „ u�: i�: i.. rn s o c', r,+n,:�..o.,
<br /> '4 k •f\ it X :,:t, ' i '�� ' .. 1 i":� ca ', ..•
<br /> °f��`J`h it rti ti7i. 'a t3,ih'. w" �4�`t:. h i':^•li„ ;t14/ �'! : ..,+;,.. ",x. , Jn.�' - ---..
<br /> ,OWNER NAME: i11L, ' R e TENANT NAME If Commercial :
<br /> OWNER MAILING ADDRESS: 3TRKT , IOcYt1 Er 5\N C1
<br /> CITY LJ��. STATE `WM ZIP q9.,
<br /> OWNER PHONE: ►7 - _ .. OWNER EMAIL:
<br /> CONTRACTOR NAME: C )
<br /> CONTRACTOR ADDRESS: STMT cr.!.
<br /> CITY ' 111 STATE
<br /> ,��. ZIP 1”. � 4111. 2 I •
<br /> CONTRACTOR PHONE: 'L Q � CONTRACTOR EMAIL:YILQ_ "TI V c
<br /> CONTRACTOR LIC.#REQUIRED; CITY OF EVERETT BUSINESS t.IC,#kREQUIRED: 0 9 •
<br /> PRIMARY CONTACT: D OWNER CONTRACTOR Q OTHER(Please Specify)
<br /> CONTACT NAME; , CONTACT PHONE;
<br /> 1th CONTACT EMAIL: - ,Lw
<br /> ril
<br /> AGREEMENT:Thereby oerllfy(hat!have reed and examined this application end know the same to be true end correct, All provldons of laws end ord noes governing this
<br /> type of work will be completed whether specified herein of not. The granting of a permit does not presume to give authOrlty to violate or cancel the provisions of any other state or
<br /> local law regulating construction or the performance of construction- That lam authorized by the owner of this property to perform the work for which application Is made and I
<br /> comply with the Siete Contractors Law 16.27 RCW and 296.200 WAC.
<br /> City of Everett Official Use Only
<br /> FEE
<br /> '*-4-S ® O
<br /> •
<br /> l , PERMIT# q , C
<br /> rl !. G� E ��® 1 - 0(51 1,
<br /> Owner/Authorized Agent Signature Date
<br /> (Revised 90H2/2015) ,
<br />
|