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gLtCTRICAL PERMIT APP!CATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT,WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 (E)everetteps©everettwa.gov I www.everettwa.gov/permits <br /> "117;-',1**,lijit4 ' • <br /> -„ • „ ;5,• , <br /> PROJECT ADDRESS: 06 -- di <br /> ,BUILDING AREA(if residential,new construction,remodel,or additia ), SF <br /> BUILDING TYPE: 0 SFR-DETACHED 0 SFR-ATTACHED 0 DUPLEX 0 MULTI-FAMILY-#OF lisrrs:. 0 COMMERCIAL <br /> USE OF BUILDING: , 4 tJtbLA.,1 1.1 <br /> , 11"irNeti,.; ?"4 +edit <br /> 114 <br /> CONTRACT PRICE OF WORK: $ <br /> tit <br /> NUMBER OF DEVICES(if low voltate,y, <br /> FIRE ALARM? 0 YES NO <br /> ASSOClitTED BUILDING PERMIT#(It-pp:Moat* <br /> DESCRIPTION OF WORK:,\iv °`' ' I iiit,t)eee <br /> P <br /> •A' W <br /> tr4±111,' <br /> • •• - •• 41,1:4 0 g <br /> OWNER NAME: .befua (.5n . a 4,1;ANT NAME Of tortiMen#0): <br /> .4 <br /> OWNER MAILING ADDRESS: STREET AliZ,T,) 1 44.4.1e) <br /> go 5:i; <br /> CITY Tly STATE <br /> OWNER PHONE; , !OWNER EMAIL: <br /> .1.1.1011 .41.81“ ,P.....***,..t.=-511104M104,40.1M <br /> CONTRACTOR NAME: • '"*"' log IL. <br /> CONTRACTOR ADDRESS: - •.4* I k 60 CtYIMITIL1145,1 <br /> , STATE <br /> rvg <br /> ZIP (03 <br /> CONTRACTOR PHONE t ZS* 07 osg 2 CONTRACTOR EMAIL: <br /> CONTriAarOR LIC.4#REI:#11REO; g CITY-DP EVERETT BUSINESS LIC.# %WIRED 2-2.64114 <br /> PRIMARY CONTACT: 0 OWNER TO-CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME CONTACT PHONE: <br /> C <br /> 84_1 -T-0,A.0 bc C <br /> oy CONTACT EMAIL: Etc,401‘ oirieN <br /> 1.4. ri- <br /> T hereby certify atl have read and examined this application and know the same to, _lrue 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 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 Cinty <br /> FEE <br /> L <br /> PERMIT# <br /> • <br /> y / 17 E krcDS — 09(-( <br /> di/inlet/A(040 ; ; Agent Signature z• (Revised 10/12/2015) <br />