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06/05/2006 06: 11 25328 6 GARNER ELECTIll PAGE 02/08
<br /> ELECTRICAL PERMIT APPLICATON
<br /> Id d
<br /> CITY OF EVERETT PERMIT SERVICES
<br /> 3200 CEDAR STREET, EVERETT, \NA 98201
<br /> (P)425-257-8810 I FAX 425-257-8857 I (E) everetteps@everet1wa-gov I www.everettwa.gov/permits
<br /> PROJECT ADDRESS: �--
<br /> 'BUILDING AREA(if residential, new construction,remodel,or addition) SF
<br /> BUILDING TYPE: ❑ SFR-DETACHED D SFR-ATTACHED LI DUPLEX X MULTI.FAMILY-#OF UNITS: co COMMERCIAL-
<br /> USE OF BUILDING:
<br /> ::..:.. . :.,... :. ., ,.. lm;;. ...�i�I��1�a�ii�i'�1r��abl�lVd�i;���1rn9�. .
<br /> CONTRACT PRICELW WORK:$ J I _
<br /> NUMBER OF DEVICES jf low voltage) — —
<br /> FIRE ALARM? D YES NO _-
<br /> ASSOCIATED BUILDING PERMIT#(if applicable): _
<br /> 1DESCRIPTION OF WORK: _
<br /> c; aIIIVW L it . 1 -
<br /> • CO$T,A,Ct NFtED MATION
<br /> OWNER NAME: Y [ } f TENANT NAME If Commercial :
<br /> OWNER MAILING ADORES STREET 1 Q ' C� 1� {�) — - i`�
<br /> CITY I STAYS `/� 21P V1n1 a
<br /> OWNER PHONE: I` or • 1 OWNER EMAIL:
<br /> CONTRACTOR NAME: ('T (� ,t�V� >.� C 104vi ',
<br /> CONTRACTOR ADDRESS: MEET 4 U2 \i CA }1p.',l
<br /> LC,YTY 9_.. �° 3TATF - 7,If C4f1 R:?7
<br /> CONTRACTOR PHONE: ' - - ', — ( ) CONTRACTOR - ' L: b_ . .'") "i. r.
<br /> CONTRACTOR CTC, �+�, _
<br /> #fi(REQUIR=e):1p�t� ` C,IC_1#RFQUlRED):b6 �
<br /> Iv Y OF EVERETT BUSINESS r
<br /> _..... . .. ...... ... ...,.-. ... .-.. ■moaw.,n,.,..,..,.,.,_.�...,.,..,i. -_ ._.-_-.-_ _..- _.. _-_....,..,..,..�,,...._.a.-....m--�„�omnmawme, . . .. .�, .....,:,�,,.......,. ti-w:, mrns�;irr� ,-��-.
<br /> PRIMARY CONTACT: DOW R aCONTRACTOR 0 OTHER(Please Specify)
<br /> cls TACT NAME: CONTACT PHONE:
<br /> ,}3(.o0__q) ••2 o3
<br /> coNrACT ENIAu_: � Y� f �L ot;
<br /> AGREEMENT:T hereby certify that I have reed and examined 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 herein or not. The granting of a permit does hot presume to give authority to violate or cancel the provisions of any other state or
<br /> local law regulating construction or the performance ofconstruCtlon. That I em authorized by the owner of this property to perform the work for which application is made end I
<br /> comply with the State Contractors l,cw 18.27 RCW end 296.200 WAC.
<br /> City of Everett(Vla/Use Only
<br /> /4--S
<br /> PERMIT of
<br /> ; t ,a, ( WIt&4 to 112.• . 1( E
<br /> Owner/Authorized Agent Signattire Date (Revised 10/12/2015)
<br />
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