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4.77- ELECTRICAL PERMIT APPICATI N
<br /> O
<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 I www.everettwa.gov/permits
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<br /> PROJECT ADDRESS: MD-a:4-w\ Tit Q�
<br /> BUILDING AREA(if residential,new construction,remodel,or addition) SF
<br /> BUILDING TYPE:)4 SFR-DETACHED 0 SFR-ATTACHED 0 DUPLEX 0 MULTI-FAMILY-#OF UNITS: 0 COMMERCIAL
<br /> USE OF BUILDING:
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<br /> CONTRACT PRICE OF WORK: $ (Sb
<br /> NUMBER OF DEVICES(if low voltage):
<br /> FIRE ALARM? 0 YES 0 NO
<br /> ASSOCIATED BUILDING PERMIT#(if applicable):
<br /> DESCRIPTION OF WORK: 91-6+07'
<br /> 1-6+ '�••'- * Q ppi��c-e_,_
<br /> OWNER NAME: &eat S'TK.II -{ toY c tv'TENANT NAME(If Commercial):
<br /> OWNER MAILING ADDRESS: STREET � �D-V-±1 (1 GtLit.,
<br /> �7 � CITY (•�y,tel�.��Q,i4 STATEititer y V GC.ZIP �g O 1
<br /> OWNER PHONE: 2-tl jp '.L1k • 31 ( I OWNER EMAIL:
<br /> CONTRACTOR NAME: t�A2-�. "�`� W�,�. 0M ,.. S`l�C-11C)YlS
<br /> CONTRACTOR ADDRESS: STREET Po 0yC. 11g
<br /> CITY 1"l sVL.tL STATE i/v X ` ,, ryZIIPP:, 9 2-1 C�
<br /> CONTRACTOR PHONE: ?j1•Q b • 1.C' "g,•) CONTRACTOR EMAIL: I tri—o COCN ` a 1(�J�(�Lit 1 • vvv ` 1
<br /> CONTRACTOR LIC.#(REQUIRED): C �-1'4C(j(<7 F-A CITY OF EVERETT BUSINESS EQUIRED): U"J 2.
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<br /> PRIMARY CONTACT: 0 OWNER CONTRACTOR 0 OTHER(Please Specify)
<br /> CONTACT NAME: CONTACT PHONE: b . bSg. 9 C
<br /> .\.Q.AJJ bes-h,(1.19LAM CONTACT EMAIL: -I r,-6 Cz f V e 6Cm \
<br /> AGREEMENT:I hereby certify that I have read and examined this application and know the same to be true and correct. All prof laws and ordinances erning this type
<br /> 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 /> 77�r City of Everett Official Use Only
<br /> a ; PERMIT#
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<br /> Owner/Aut rued Agent Signature Date (Revised 9/23/2016)
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