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ELECTRICAL PERMIT APPLICATION
<br /> CITY OF EVERETT PERMIT SERVICES
<br /> 3200 CEDAR STREET, EVERETT, WA 98201 •
<br /> (P)425-257-8810 FAX 425-257-8857 I (E) everetteps@everettwa.gov I www•everettwa.govlpermits
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<br /> PROJECT ADDRESS: L 6-:;214 I.A.,)e :. . � UO t .�t+itelbeY r`�~(
<br /> BUILDING AREA(If residential,new construction,remodel,or addittO i) SF
<br /> BUILDING TYPE: ❑SFR DETACHED IJ SFR, �
<br /> ATrACH�E,D Elb DUPLEX MULTI-FAMILY-#OF UNITS: NI COMMERCIAL
<br /> USE OF BUILDING: r D 145 Ellg l
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<br /> CONTRACT PRICE OF WORK:$ 1.6 coo
<br /> NUMBER OF DEVICES(if low voltage):'
<br /> FIRE ALARM? Cl YES 14 NO
<br /> ASSOCIATED BUILDING PERMIT#(If applicable): •
<br /> DESCRIPTION OF WORK: POV t01,05C r"7();)„.
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<br /> • • Y • ::r, 0����.y■AC '.INFORMll rJ0I11 •, . - _,t... :�I .1,1•
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<br /> OWNER NAME: TENANT NAME(If Commercial): B'IG/A.,)
<br /> OWNER MAILINGADDRESS: STREET Po .4x 3707 /,
<br /> CITY S rL ,E STATE �/i 1Q
<br /> ZIP / /2'/"22O7
<br /> OWNER PHONE: OWNER EMAIL:
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<br /> CONTRACTOR NAME: 4e;o�•I( 'L I�S7 l-
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<br /> CONTRACTOR ADDRESS: s7RearyyPPd2 eox Oce
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<br /> CONTRACTOR PHONE:426-2,,1 4444 CONTRACTOR EMAIL: kit-,ej. thetiUl'�E—gip tg/i7". &
<br /> CONTRACTOR LIC.#(REQUIRED): (,�+�Ai8ge. .1Q`�'{�.� CITY OF EVERETT E USINESS LTC.#(REQUIRED):01410 .21.—
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<br /> PRIMARY CONTACT: ❑OWNER NI CONTRACTOR ❑OTHER(Please Specify)
<br /> CONTACT NAME: CONTACT PHONE: 204>-736--6 s/ ep
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<br /> >C D ou CONTACT EMAIL: DEAN f I S.�1e.0L Y! k i 1 T.
<br /> AGREEMENT'T hereby certify that 1 have read end 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 whetherspecfffed herein or not. The granting of a permit does not presume to give authority to violate or cancel the provisions of any other state of
<br /> local law regulating construction or the performance of construction. That t am authorked 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 288.20d WAC
<br /> City of Everett O(ryclal Use Only
<br /> FEE
<br /> .-
<br /> •
<br /> PERMIT#
<br /> t'°005'--.(1.121
<br /> Owner!Au orized Ages Signature Date (Revised 10/12/2015)
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