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477 ELECTRICAL PERMIT APPLICATION
<br /> CITY OF EVERETT PERMIT SERVICES
<br /> ORIGIN
<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 /> Aimb , ; . :2 ,111t41:1 ,;57rte. eta_ JE I?›E, u--7---4-11 AT ,i A- ,,
<br /> PROJECT ADDRESS: 1M '' e,t/deAVr IV
<br /> BUILDING AREA(if residential,new construction, remodel,or addition) y...6il[jn /dSF
<br /> BUILDING TYPE: SFR-DETACHED 0 SFR-ATTACHED 0 DUPLEX 0 MULTI-FAMILY-#OF UNITS: 0 COMMERCIAL
<br /> USE OF BUILDING:
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<br /> �lIF j�,ti .'n'°'. ry .�- °. �T .y ' �U GIS*..,. -.'4, ,iG iIi"ii i, �`�. /000J1+1+61%!=.-S'i' "5 �) (I(�x. ��S�IF;1�4 '" Vii.
<br /> '.,,w m", }' ui i 4 Bary 44 .,41014mi Om xi ,==lb0 t-x „�r"rfiIL;o1 _s i �,J++k ( �;,
<br /> CONTRACT PRICE OF WORK:$ ( (.
<br /> NUMBER OF DEVICES(if low voltage):
<br /> FIRE ALARM? ❑YES ❑NO
<br /> ASSOCIATED BUILDING PERMIT#(if a plicable):
<br /> DESCRIPTION OF WORK: A C. rii- r ha' F6vrip ir471)
<br /> �� XY _ CONTACT INFOIRNIATION ,
<br /> OWNER NAME: . - (,(,I/ Uh TENANT NAME(If Commercial):
<br /> OWNER MAILING ADDRESS: STREET 1 Zt gat,fel fey J V�
<br /> cITY FV.r, STATE LOA" ZIP �l
<br /> OWNER PHONE:11lb'�, 10-' 1�' OWNER EMAIL: Letal Ij ,1 .raviC t1Z 'wJ,t nvi edm
<br /> CONTRACTOR NAME: Nup V
<br /> CONTRACTOR ADDRESS: STREET
<br /> r ,� 11 q' 'Z //!!• i ) I I //��
<br /> CITY WOO J6' Xi-la
<br /> /3 lei
<br /> ''V Tlvr///�€e STATE (j J ZIP We I
<br /> CONTRACTOR PHONE:1f j ?•7 1 1 isq CONTRACTOR EMAIL: 11/40 0b 0/VOMfdlitte
<br /> CONTRACTOR LIC.#(REQUIRED) .d F(r 41463/ 0-1 CITY OF EVERETT BUSINESS LIC.#(REQUIRED)'111.0
<br /> PRIMARY CONTACT: 0 OWNER - CONTRACTOR 0 OTHER(Please Specify)
<br /> CO ACT NAME: I CONTACT PHONE: / 1
<br /> grin In
<br /> CONTACT EMAIL:in �� I") / t'�at/►�rJ�►Q�r-}-��'n�
<br /> 410
<br /> AGREEMENT:T hereby certify that I hay ead and mined this application and know the same to be true-nd correct. All provisions of laws and ordinances governing this
<br /> type of work will be completed whether specified here, 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
<br /> q—S_ e------
<br /> PERMIT#
<br /> k— A .....7 (/ r.i UN/Ig E l'51.0� -- Vce
<br /> Owner/ •""" • C - ,gent Signature Date (Revised 10/12/2015)
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