|
ELECTRICAL PERMIT ikPPLICATION .
<br /> 00111011P.4
<br /> ,,1. ilkya CITY OF EVERETT PERMIT SERVICES
<br /> 3200 CEDAR.STREET, EVERETT,WA 98201 .
<br /> (F')425•-257.8810 J FAX 425-257-8857 J (E)everetteps@everettwa.gov J www.everettwa.gov/permits
<br /> 23::1:211:.:;:'::;.;...,v..::.7;...;:: : r:J 57:•a::iY;-R.i. 274 .:p-....... _..- .,.a•,p::�rtp• „yvw�+. •ti�� -1• h•..rar ..a`�.,a..._,F i.a: y.
<br /> J�J/ .:•.--.�.r4i t- �.•. .. . .. '4:•�:fW:'�S-•.L.t�.•�/i.l.•VF.•.ti.fn]....�F.,••!1i•5��4:t:�i,S•�i•.iMWxL• iv. . ../.'.. . ._�......a... .._ .-i.•-.1:-,•• .. Y..:7••r.C•:-:.y',
<br /> PROJECT ADDRESS: (t) oe-''"l y t �� 1(1.i 0 0 f (sL{ b <.. : :......1•.."
<br /> BUILDING AREA(if residential,new construction,remodel,or addtt[6n) SF . '
<br /> DUiLDING TYPE: CI"SFR DETACHED 0 SFR ATTACHED 0 DUPLEX la MULTIFAMILY-#OF UNITS', NI COMMERCIAL
<br /> USEOFBUILDING: EQ.E.s G EVIGtP T .
<br /> �,�a�f"f��j't�:i::':u,29ip ni4 `i- _ �Si'::£'<nr;•,+i ,.s•k•••y ,4.. a.-d, i..o-4+.e .:e• ,•,2•':a,�:•i.„�. v};l.ra.7,4.,.�pi�,Y�,',.•'—Y
<br /> r :,, ,C�${�,,�,�y[}trio iakifi ILiy/`yJj.(�;, •e.��.��q(.. Y/�,�•I�t11irktiCt�N"ip �.
<br /> ..ab1'..,....ti•i4..,,. >.t:.a••tv!-...........„ .a..•N,A4.......,,!,....,.....'Ait✓>L..:N;v-rata- .4- . i,;.;.. i1Fn•.1,•ro.Kr1.......1••.3+'i........a:,U,;s4,7,,7i••. .L*ii4g.ZI:,;;a(a V:.,1,1,a114i
<br /> CONTRACT PRICE OF WORK:$ 1 �/ 000
<br /> NUMBER OF DEVICES(If low voltage):•
<br /> FIRE ALARM? ❑YES PI NO
<br /> ASSOCIATED BUILDING PERMIT 0(if applicable): •
<br /> DESCRIPTION OF WORK: l ?I/7)r..--,. )i 0 W I t..e(ej 0 70 2 Tat-)1 ( v")
<br /> •
<br /> •
<br /> . ,:.',f.:1:-.:1,....1"...:;.',V.::,
<br /> ,..:1:,. . z:..,'.. .•i • . _,T... ...:::/:......•-• .. ..COYy'TACT.:)0,9- .1:4010 =., ., . •.
<br /> OWNER NAME: TENANT NAME(If Commercial): /A.)6
<br /> OWNER MAILING ADDRESS: s7REer PO i'X 3707 •
<br /> CRY .5EArrL8 STATE VV/14 /2'2207
<br /> OWNER PHONE: OWNER EMAIL:
<br /> CONTRACTOR NAME: ('.,• /O ,e z. C.�,v57--j2•ucTc
<br /> ia )
<br /> CONTRACTOR ADDRESS: srRnar Poi -eox 4 ,
<br /> CITY )7) /L.7-&-7.9 STAT&- ZIPggZo4 -
<br /> CONTRACTOR PHONE:426-294-61 CONTRACTOR EMAIL: k,�',R.I, mlYtE7gell ki wir, el
<br /> CONTRACTOR LIC,#(REQUIRED: (��/�t�l�� 1QZ CITY OF EVERETT CiSINESS LIC.#(REQUIRED):0210
<br /> PRIMARY CONTACT: 0 OWNER XI CONTRACTOR 0 OTHER(Please Specify) w ^µ ~
<br /> CONTACT NAME: , Q 1 CONTACT PHONE: 204,-736-654/p�j �tkik-WI
<br /> l i1i N 15 £!eD ut! CONTACT EMAIL- DENT'l g.[�,.1�Ok a T. 1D
<br /> AGREEMEN7:T hereby certify that t have read and examined this application and know the same to be true and correct All provisions of laws and ordinances governing this
<br /> type ofwodcwlllbecompleted whetherspeclfladherein ornot The granting of a permit does not presume to give auThorityto violate or cancel The provisions of any other state or
<br /> focallawregulating 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 RCCWand 296.200.WAC.
<br /> City of Everett Official Use Only
<br /> �FEE ���� � av
<br /> PERMIT/#*4/4 Al i. / • E II S050.-)( , 6
<br /> _.
<br /> Owned,u or ed Agen Signature Date (Revised 1 0/1212016)
<br />
|