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ELECTRICAL PEc\MIT APP UC,-'zTJON
<br /> CITY OF EVERETT PERMIT SERVICES
<br /> 3200 CEDAR STREET, EVERETT,WA 98201
<br /> (P)425-257-8810 I FAX 425-257-8857 1 (E)everetteps@everettwa.gov j www.everettwa.govlpermifs
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<br /> PROJECT ADDRESS: • R\ .kV\ et t.tAnan -L
<br /> BUILDING AREA(if residential,new construction,remodel,or addition) SF ,
<br /> BUILDING TYPE: 0 SFR DETACHED Li SFR-ATTACHED 0 DUPLEX El MULTI-FAMILY-#OF UNITS: I COMMERCIAL
<br /> USE OF BUILDING: oe-/ EV Err • •
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<br /> CONTRACT PRICE OF WORK:$ L.4, 0
<br /> NUMBER OF DEVICES(if low voltage):
<br /> FIRE ALARM? C7 YES v4 NO
<br /> ASSOCIATED BUILDING PERMIT#(if applicable): •
<br /> DESCRIPTION OF WORK: "°`A �'✓r ,` i
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<br /> �: _...•.. : .. :' • _. :,-:*...0.154..t.4.0[',.INF ;R i1I:A**
<br /> OWNER NAME: TENANT NAME(If Commercial): A.)6
<br /> OWNER MAILING ADDRESS: srrteer f ? &9)( 3707 •
<br /> 5E4ITLE STATE Wig m //2'2247
<br /> OWNER PHONE: OWNER EMAIL:
<br /> CONTRACTOR NAME: - iv , e`Q,.)5n,u(_'7'o/C3
<br /> CONTRACTOR ADDRESS; STREET y Po •eox�41,, ', ,1[ L�
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<br /> CONTRACTOR PHONE:426-2,94 4'g44 CONTRACTOR EMAIL: kille./. H. '/)') � 42 k/ -w,r1 &2 t
<br /> CONTRACTOR LIG,#(REQUIRED): 6�Al gCc� 0 Z _ ICITY OF EVERETT[ USJNESS LIC,#(REQUIRED):01/01/
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<br /> PRIMARY CONTACT: ❑OWNER KI CONTRACTOR EI OTHER(Please Specify)
<br /> CONTACT NAME: CONTACT PHONE: 206-7 3 b—654-/0
<br /> • p-1Y 1415 £ C)W CONTACT EMAIL: DEKA/I S.C'i.go.ty a Ti ik iT. oM
<br /> AOREEIVIENT:T hereby cent”that I have read end examined this application and know the same to be true and correct. All provisions of laws and ordinances governing this
<br /> type of workwllibe completed whetherspeibtled 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 owner of this property to perform the work for which application is made and t
<br /> comply with the State Contractors Law 18.27RCW and 298.20d WAC.
<br /> City of,Everett Ocdal Use Only
<br /> FEE, f
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<br /> PERMI #
<br /> E I be -(2C0'
<br /> Owner/Au o zed Agent Signature
<br /> nature Date (Revised 10/12/2015)
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