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ELECTRICAL PPLUCAT1SN
<br /> � R CITY OF EVERETT PERMIT SERVICES
<br /> - 3200 CEDAR STREET, EVER Iw 1 I,WA 98201
<br /> (P)428-257-88110 ( FAX 425-257-8857 ( (E)everetteps@everettwa.gov I www.everettwa.gov/perrni-ts •
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<br /> PROJECT ADDRESS: '�p6/.41/ 67sOr j/4., A.
<br /> BUILDING AREA(if residential,new constructionmodeJ or addition) SF
<br /> BUILDING TYPE: 0 SFR DETACHED Ei SFR ATTACHED ❑DUPLEX IA MULTI-FAMILY-#OF UNITS: • NI COMMERCIAL
<br /> USE OF BUILDING: DEI_-., EVERETT
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<br /> CONTRACT PRICE OF WORK:$ a da
<br /> NUMBER OF DEVICES(if low voltage):•
<br /> FIRE ALARM? Cl YES NO
<br /> ASSOCIATED BUILDING PERMIT#(if applicable):
<br /> DESCRIPTION OF WORK: 9P/2/67-20 �LC'Jd G% ' " 5.z• to2,
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<br /> OWNER NAME: TENANT NAME(If Commercial): /11.}6
<br /> OWNER MAILING ADDRESS: STREET p% an( 37D7
<br /> OjTt' ; -LE- STATE tit//- 4 1g/2}-2207
<br /> OWNER PHONE: OWNER EMAIL:
<br /> CONTRACTOR NAME: 4eL ' '
<br /> . 5nell(.T/d/0
<br /> CONTRACTOR ADDRESS: STREET P2 SOX 440
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<br /> CONTRACTOR PHONE:426-2/4 4/44 CONTRACTOR EMAIL: kitiet, 4/! i 2 / �//�. 60/Y)
<br /> CONTRACTOR LIC.#(REQUIRED): GE/) 4j'/OZ CITY OF EVERETT IIUSINESS LIC.#(REQUIRED):o405
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<br /> PRIMARY CONTACT: D OWNER ,NI CONTRACTOR 0 OTHER(Please Specify)
<br /> CONTACT NAME: �,1 CONTACT PHONE: 206-'736-4544,
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<br /> 1'N4t5 &.D[(v CONTACT EMAIL: DEN 1S �l�o+t!Y! (�tCVI/f�T. do/yi
<br /> AGREEMENT:T hereby certify that I have read and examined this application and know the same to be true and correct. All provisions oflaw•s 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 slate or
<br /> local law regulating construction or the perfomnance of construction. That tem 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 2TRCW and 296.20d WAC.
<br /> City of Everett Official Use Only
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<br /> PERMIT#
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<br /> Owner/Au zed Agen Signature Date (Revised 10/12/2015)
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