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<br /> ELECTRICAL PERMIT APPLICATION •
<br /> '144/---: /;-;: -74 .
<br /> -_ CITY OF EVERETT PERMIT SERVICES
<br /> 3200 CEDAR STREET, EVERETT,WA 98201
<br /> (P)425-257-8810 J FAX 426-267-8857 1 (E)everetteps@everettwa.govI www.everettwa.govlpermits
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<br /> PROJECT ADDRESS: '347 4 131,d4' -P...0-14/..401_, 7 3
<br /> BUILDING AREA(if residential,new construction,remodel,or addition) SF '
<br /> BUILDING TYPE: El SFR-DETACHED 0 SFR-ATTACHED 0 DUPLEX El MULTI-FAMILY-#OF UNITS: NI COMMERCIAL
<br /> USE OF BUILDING: r 06.1146 EVee T7-
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<br /> CONTRACT PRICE OF WORK:$ ""3//000
<br /> NUMBER OF DEVICES(if low voltage):•
<br /> FIRE ALARM? CI YES /iil NO
<br /> ASSOCIATED BUILDING PERMIT#(if applicable):
<br /> DESCRIPTION OF WORK: f f /4$4)36012 4 5.- L
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<br /> OWNER NAME: TENANT NAME(if Commercial): /10
<br /> OWNER MAILING ADDRESS: sTREEr Pal,atm 3707 Wit
<br /> `/� �( [�/ J 7
<br /> cnY .5GTf f L+ STATS y{/i t 2Pei /2•[-22O
<br /> OWNER PHONE: OWNER EMAIL:
<br /> CONTRACTOR NAME: 2 )J �5 ZG//7 /d(
<br /> CONTRACTOR ADDRESS: STREET' Po &>X 41,
<br /> mrfmag IL-1 2 sTATaIAM 21,1g204 .
<br /> CONTRACTOR PHONE:426-294-. 944 CONTRACTOR EMAIL: k4le.1. 144lli YIEieo}k/ 'w/7"' 60111
<br /> CONTRACTOR LIC, gCC Q Z CITY OF EVERETT BUSINESS LIC.#(REQUIRED):04051
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<br /> PRIMARY CONTACT: D OWNER (3l CONTRACTOR D OTHER(Please Specify) -
<br /> CONTACT NAME: CONTACT PHONE: 204)-73 6-6544 .
<br /> . l) N iki1 S 6417 ui CONTACT EMAIL: DEN A'1 S.6g„,04.)® k 1.Vi/1 T. d...oM
<br /> 'AGREEMENT:Thereby certify that I have mad and examined this application and know the same to be true and correct. All provisions oflaws 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 taw regulating construction or the performance of construction, That t am authorized by the owner of this property to perform the work for which application is made and i
<br /> comply with the Slate Contractors Law 18.27 RCW and 236.200'WAC.
<br /> City of Everett Official Use Only
<br /> FEE S5
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<br /> •
<br /> PERMIT#
<br /> •
<br /> - / 'I, E VSZnq — (Lk 2---
<br /> Owner/Au a zed Agen Signature Date (Revised 10/12/2015)
<br />
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