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ELECTRICAL PERMIT APPLICATION
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<br /> CITY OF EVERETT PERMIT SERVICES
<br /> vii3200 CEDAR STREET, EVERETT, WA 98201
<br /> (P) 425-257-8810 I FAX 425-257-8857 1 (E) everetteps@everettwa.gov I www.everettwa.gov/permits
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<br /> PROJECT ADDRESS: I 1 •
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<br /> BUILDING AREA(if residential, new construction, remodel, or addition) LA- 2( SF
<br /> BUILDING TYPE: 0 SFR-DETACHED 0 SFR-ATTACHED 0 DUPLEX IV MULTI-FAMILY-#OF UNITS: ' ' 0 COMMERCIAL
<br /> USE OF BUILDING: 140tAS O % AkAYtor .-Fi
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<br /> CONTRACT PRICE OF WORK: $ 0i orf)
<br /> NUMBER OF DEVICES (if low voltage): th
<br /> FIRE ALARM? ❑YES NO 'T e eX^ E?Ot i5 Lkfo n"\l` h(
<br /> ASSOCIATED BUILDING PERMIT#(if applicable): `
<br /> DESCRIPTION O
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<br /> OWNER NAME: v-e -i-t-- k_ kk.NYA a a ENANT NAME (If Commercial): R c
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<br /> OWNER MAILING ADDRESS: STREET R q.'_')(,) 'i))( 1 1
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<br /> OWNER PHONE:C(t 7J �`~�.f i'. ' -A.,),i ,. . OWNER EMAIL:_
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<br /> CONTRACTOR NAME: S JS _ 11'' hL_ LA7t1 1 — . ct vVr+ Aced iVi.1.17
<br /> CONTRACTOR ADDRESS: STREET 0 1)O,' C5 4)
<br /> CITY LAT-1Y\ V i O..- -i STATE \I P ZIP CA ?DM-ACV
<br /> CONTRACTOR PHONE:(41I7C5)LH C''•1O CONTRACTOR EMAIL: Fv--('.(�1.{i6 SLf i iii,-(f i'15'ink\ COO.:
<br /> CONTRACTOR LIC.#(REQUIRED): S 1I S t e,5
<br /> .0\i 1 O) RI) CITY OF EVERETT BUS ESS LIC.#(REQUIRED): O 31 L 1
<br /> PRIMARY CONTACT: 0 OWNER jfi CONTRACTOR 0 OTHER(Please Specify)
<br /> CONTACT NAME: CONTACT PHONE: l "'I GC- 2,L.I C Z3�?(jj
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<br /> AGREEMENT:T hereby certify that I have read and examined this application and know the same to be true and correct. All proe cions 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.
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<br /> FEE U_ G1fX v(EveiCtt©ffl�lal Usb On
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<br /> PERMIT#
<br /> 012
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<br /> E1DI .
<br /> Owner/Authorized Agen nature Date (Revised 10/12/2015)
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