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0*Err MECTRICAL PERMIT AP (CATION
<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: \12'3 Rc c r A - - ..„r 'tA'- 'NA $a*°
<br /> BUILDING AREA(if residential, new construction, remodel, or addition) yLDlt O SF
<br /> BUILDING TYPE: 0 SFR-DETACHED 0 SFR-ATTACHED 0 DUPLEX IPA MULTI-FAMILY-#OF UNITS: 0 COMMERCIAL
<br /> USE OF BUILDING: !--'-QkAc$\'696 A.lk-110,r.
<br /> �.} �� {I x'"'74 �• t , Y.t Y
<br /> • ,. , ..SA.•�" s,yek. .c\«,r r.::::'.i ,� itr�.,u, t ri`
<br /> CONTRACT PRICE OF WORK: $ "- l'l
<br /> NUMBER OF DEVICES (if low voltage): 4
<br /> FIRE ALARM? 0 YES I NO L t'+ ((' 1 L&.b f•� ` -o,,(
<br /> ASSOCIATED BUILDING PERMIT# (if applicable):
<br /> DESCRIPTION OF WORK: Ljc y i yn re -N-0,4,G, - .
<br /> 1. i 4 tt?ae,44 } Y y.x.,,'¢3. f 7..I.A S '''r
<br /> '' i,Y t I i' kt�[vu yb;.4 .+ wtV�: ?r 'Ct i ri,r+ �� a A. 3� J�, f
<br /> Y.' ,a'S ..t r �* .t ,4',4':.a,.tgiR'Ail'� 'A. . 4,-'...}?a � r:: ,:;.-i, fir.t,�..,,V4Y4 »c.5?5 A i } -'1 `" ; } ...�5:, y�. :,:t: �` (0,
<br /> .vizi, Krt,. ..'Wt,, „C4 1, .• �lw. .n .. .d1 .FM .4
<br /> OWNER NAME: T _\f?_v - -• \-\--- N kk x ENANT NAME(If Commercial): R cc,Y.... D y I
<br /> OWNER MAILING ADDRESS: STREET u
<br /> crry V ve fiz STATE ` 'A ZIP ��: 2,,c5--0
<br /> OWNER PHONE:C(4'1.? ,c, 'otOWNER EMAIL:
<br /> CONTRACTOR NAME: J teiii )6-1,(.11/1L.1 j VI,S (f, `fiI m hrP()l 1211\( r''t.,.__
<br /> CONTRACTOR ADDRESS: STREET ?0 oI)X- i;.)? - 15
<br /> CITY L!, el kr\\Ni Ols>. STATE ZIP CA t%:3 ./�y
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<br /> CONTRACTOR PHONE14:k2Fi J 7,1.1 Ci'-1.0 !CONTRACTOR EMAIL: FV:eCk kiss.1€ `i1/44 4411 JI t,,k,-(-(6(151;kk 0.140
<br /> CONTRACTOR LIC #(REQUIRED). I 1 t J W c1 00 pi) CITY OF EVERETT BUS /� 4,11
<br /> ,.,13 r,. G,•..�..,.,.�,.... ,Y.. .., ,..,r,•c . tea. .,n c�yT f „
<br /> ESS LIC #(REQUIRED). "
<br /> PRIMARY CONTACT: 0 OWNER ]CONTRACTOR 0 OTHER(Please Specify) .
<br /> CONTACT NAME: CONTACT PHONE: Li 2C j L-1 C'` .. 7_0---"k0
<br /> )Q.e-- ��cAo �rEP,\II,l,`jII NY(:(6),-(i k-k(''(NIIN.FONTACTEMAIL: (-_,,i [f`, k_.cr„,.,` 'i:11' 1,,,,,i,',r,s"v./c�.c_incr,.
<br /> AGREEMENT:T 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
<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 CvthCIt Offh,lal Lye OtnY..
<br /> FEE
<br /> 4 5-0, --
<br /> PERMIT#
<br /> INstr ,.---73--..;,,, r_____
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<br /> Owner/Authorized Agen`6' nature Date (Revised 10/12/2015)
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