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ELECTRICAL PE 's MT APPLUC T10 N
<br /> CITY OF EVERETT PERMIT SERVICES
<br /> 3200 CEDAR STREET,EVERETT,WA 98201 •
<br /> (P)425-•257-8810 1 FAX 425-257•-8857 j (E)everetteps@everettwa-gov f www.evereftwa•gav/permits
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<br /> PROJECT ADDRESS: L�15- IN e-Al ( di .61 IA m ,1—
<br /> BUILDING AREA(if residential,new construction,remodel,or addition)- SF ,
<br /> BUILDING TYPE: D'SFR DETACHED ❑SFR-ATTACHED ❑DUPLEX El MULTI-FAMILY-#OF UNITS; COMMERCIAL
<br /> USE OF BUILDING: 0e 'k ; EI/E -7 r •
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<br /> CONTRACT PRICE OF WORK:$ 13/ DO 0
<br /> NUMBER OF DEVICES(if low voltage):
<br /> FIRE ALARM? Cl YES NO
<br /> ASSOCIATED BUILDING PERMIT#(if applicable): •
<br /> DESCRIPTION OF WORK: '\ PM E OM))u) }1P (,O-7c1 Te6 I, ,, 4
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<br /> OWNER NAME: TENANT NAME(if Commercial): jN6
<br /> OWNER MAILING ADDRESS: STREET pa ,�y�•.)( 5707 •
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<br /> CU? el�.e EA 1 LE STATE A- 710,612 ' 2207
<br /> OWNER PHONE: OWNER EMAIL:
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<br /> CONTRACTOR NAME: 6e/0g epX�5neUe....Tlt7it)
<br /> CONTRACTOR ADDRESS: smREer P0 Box 44
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<br /> CONTRACTOR PHONE:426-2/4-6144 CONTRACTOR EMAIL: k4i i. metinpli�, Nk/ �1jf/�'1 &?iYi
<br /> CONTRACTOR LIC,#(REQUIRED): 6ENegC $4a z CITY OF EVERETT BUSINESS LIC.#(REQUIRED):01405.1.L.
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<br /> PRIMARY CONTACT: C7 OWNER Ei CONTRACTOR El OTHER(Please Speci(y) '
<br /> CONTACT NAME: , f CONTACT PHONE: 206-7 s 6-(0 5 4v
<br /> (1t& ! CONTACT EMAIL: DENA/I e.,AOL)6 ki •vI/i r. oM
<br /> AGREEMENT T hereby certify that!have read and examined this application and knowihe 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 authorityto violate or cancel the provisions of any other state or
<br /> local law regulating construction or the performance of construction. That lam authorized by the owner of this properly to perform the work for which application is made and!
<br /> comply Oh the State Contractors Law 18.27 RCW and 295200 WAC.
<br /> City of Everett Official Use Only
<br /> FEE D � r�
<br /> PERMIT#
<br /> E 05- o(0L4
<br /> Owner/Au or zed Agent.Signature Date (Revised 10/12/2015)
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