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<br /> ELECTRICAL PERMIT APP UC A\TION
<br /> _ - CITY OF EVERETT PERMIT SERVICES
<br /> 3200 CEDAR STREET, EVERE I I,WA 98201
<br /> (P)425-257-8810 I FAX 425-257-8857 I (E)everefteps@everettwa.gov I www.everettwa.govlpermits
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<br /> PROJECT ADDRESS: -1/ •OCelf/ t/0�, I-5.
<br /> BUILDING AREA(If residential,new construction,remodel,or addition) SF
<br /> BUILDING TYPE: El SFR-DETACHED Ei SFR-ATTACHED El DUPLEX El MULTI-FAMILY-#OF UNITS: NQ COMMERCIAL
<br /> USE of BUILDING: QETI4 EVERETT' •
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<br /> CONTRACT PRICE OF WORK:$ 00,0
<br /> NUMBER OF DEVICES(if low voltage):
<br /> FIRE ALARM? D YES $j NO
<br /> ASSOCIATED BUILDING PERMIT#(if applicable):
<br /> DESCRIPTION OF WORK: Pozeie1 z.) 'z z
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<br /> 'i',ACT;1NFORivi j 14. ' - Y
<br /> OWNER NAME: TENANT NAME(If Commercial): 'CE1106
<br /> OWNER MAILINGADDRESS: srsEEr Pa sox 3707 i
<br /> cmi EAi't-LE STATE � tir /G/2q".2207
<br /> OWNER PHONE: OWNER EMAIL:
<br /> CONTRACJO:R NAME: EtP�tzejposTrztie..ritmi
<br /> CONTRACTOR ADDRESS: MEET Po $Ox 4/e
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<br /> CONTRACTOR PHONE:• 5-299 4144 CONTRACTOR EMAIL: kitJAI. r7�j/1'l/Y?E'rge�i -tvir, eons
<br /> CONTRACTOR LIC.#(REQUIRED): got.t e �`40 Z CITY OF EVERETTEIUSINESS LIC.(#(REQUIRED):0140�
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<br /> PRIMARY CONTACT: D OWNER Et CONTRACTOR 0 OTHER(Please Specify)
<br /> CONTACT NAME: p ��/ CONTACT PHONE: 204,-7 3 c 7-454-4'
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<br /> t•.,e0U� CONTACT EMAIL: DENTt S.C'.KOL J® kiEw/i?. G„,OIYI
<br /> AGREEMENT.'T hereby cerlik that 1 have read and examined this application and know the same to be true and correct. Ail 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!am authorized by the ownerof this property to perform the work for which application is made and 1
<br /> comply with the State Contractors Law 9827 RCW and 296.200'WAC
<br /> City of Everett Official Use Only
<br /> FEE IA
<br /> • 700
<br /> • • PERMIT#
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<br /> Owner/Au or zed Agen Signature Date (Revised 10/12/2015)
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