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"SIIIP ELECTRICAL PERMIT APPLICATION
<br /> CITY OF EVERETT PERMIT SERVICES
<br /> 3200 CEDAR STREET, EVERETT,WA 98201
<br /> (P)425-257-8810 1 FAX 425-257-8857 1 (E)everetteps@everettwagov1 ww.everettWa,goviperrnits
<br /> ;Z:',,N.M-01,,,4-0:,‘A.VA1-7. PWRi-pte:i5R4f0,-**,- :.; *Ifitti.40 --SiatiiiitzSg;;;?:3ni-,-.-- -6s, -.,'.::i:c'M'OUVe4-_-2•:-',.,?-,;.-:-, :-,-,J..
<br /> -14,-1-:-.-1- iie----.---,,----:-.0:,---.ci,:k--.:,-,.=--,,,,;--.5,-77:.,w.-wv.e-,x:-,,,
<br /> PROJECT ADDRESS: /c//3 Pi/19,614.44.14731- jillir.--
<br /> BUILDING AREA(if residential,new construction,remodel,or addition) SF
<br /> BUILDING TYPE: eSFR-DETACHED 0 SFR-ATTACHED 0 DUPLEX 0 MULTI-FAMILY-#OF UNITS: 0 COMMERCIAL
<br /> USE OF BUILDING:
<br /> CONTRACT PRICE OF WORK:$ jryt ir7- ' " -•
<br /> OF DEVICES(if low voltage):
<br /> FIRE ALARM? 0 YES 0 NO
<br /> ASSOCIATED BUILDING PERMIT#(if appliCable):
<br /> DESCRIPTION OF WORK: r-e-1--vz) -1---6.i-a-i- ti.-. reaehriea f-urha Oe
<br /> ''.,l' '":::',' '::(':2YS:C;;:' ''''''''' '''',:;• '':''''''''''''''':::: :": :: ::2:‘,''.:*0*14iCtIOSR:1***104:: :';' :' ,: ;':
<br /> •OWNER NAME: III err-eS-e- Co r-12-r-e TENANT NAME(If Commercial):
<br /> /69 i-3 1 1,241 bz-1,51-. t11e...-
<br /> OWNER MAILING ADDRESS: STREET , , , _ . , ,- .,-.. „
<br /> IS,
<br /> Crrl g4.01W'er,44--- STATE 1,..4.26k, ZIP Ci c°79/6 ''
<br /> OWNER PHONE: tz -6:t' . 0.,. ..--3 .2.24, OWNER EMAIL:
<br /> CONTRACTOR NAME: il 0 rd6t11)771 (Yea....4-1-4.i-) '4-/4t4 —
<br /> CONTRACTOR ADDRESS: amEET 47 i' ) 07 A-1-A-el- 14
<br /> en, peyiayy. •V i I .I.Z._. STATE 1„.06t. ZIP.'q r J.---7 0
<br /> CONTRACTOR PHONE: 3447e, ---3 -q /cig43-- CONTRACTOR EMAIL:
<br /> CONTRACTOR M.#(REQUIRED):il 0 pi'.5,h4 5,,!,,-977-13 CITY OF EVERETT BUSINESS LIC.#(REOUIRED):p 4-7-j74-/I
<br /> PRIMARY CONTACT: 0 OWNER /Er-CONTRACTOR El-OTHER(Please Specify)
<br /> CONTACT NAMr , CONTACT PHONE: ..,.370b - 9ci)- - e-'::: 8---i q
<br /> •
<br /> ;,,,
<br /> AGREEMENT I hereby certify that I have read and examined this application and know the same to be true and correct. All provisions of laws and ordinances governing this type
<br /> ofwork wN 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!
<br /> comply with the State Contractors Law 11127 RWand 296.200 WAC.
<br /> City of Everett Official Use Only
<br /> PERMIT#
<br /> ) L.-
<br /> .,
<br /> '1. -, ),4011\-
<br /> Owner/Authorized Agent Sii re Date (Revised 9/23/2016)
<br />
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