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ELECTRICAL PERMIT r•_ PPUUCAT1ON
<br /> CITY OF EVERETT PERMIT SERVICES
<br /> 3200 CEDAR STREET, EVERETT,WA 98201 •
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<br /> (P)425-257-8810 j FAX 425-257-8857 I (E)everetleps@everettwa.gov J wvww.everettvva,gav/permits
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<br /> PROJECT ADDRESS: U d / 0� ' r�(I pin re
<br /> BUILDING AREA(if residential,new construction,remodel,or addition) SF ,
<br /> BUILDING TYPE: D'SFR-DETACHED El SFR-ATTACHED D DUPLEX El MULTI-FAMILY-##OF UNITS: COMMERCIAL
<br /> USE OF BUILDING: 0E111/416 E VeeLfir •
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<br /> CONTRACT PRICE OF WORK:$ I .7S
<br /> NUMBER OF DEVICES(If low voltage):-
<br /> FIRE ALARM? DYES VI NO
<br /> ASSOCIATED BUILDING PERMIT#(if applicable):
<br /> DESCRIPTION OF WORK: WYE.� ' ��.'.� (g 6 6 7
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<br /> OWNER NAME: TENANT NAME(If Commercial): ift..)6
<br /> OWNER MAILING ADDRESS: smear 190 gae 5707
<br /> orny .504-T7—GE STATE W/1- 2IPgl221.2267
<br /> OWNER PHONE: OWNER EMAIL:
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<br /> CONTRACTOR NAME: 6e,06r/it (1_ /(.J577W(.rJ),t
<br /> CONTRACTOR ADDRESS: STREET Pe2 Box 4/ //��!�/
<br /> CITY` )7)L /G7 2 srAT�4- ZP/(g2L/ L
<br /> CONTRACTOR PHONE:425"294`6944 CONTRACTOR EMAIL: killed h�4��nE-g4 'i ir. Dorf
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<br /> CONTRACTOR LIC.#(REQUIRED): M u ra 6EAIE,eC 1o z ®M r,CITY OF EVERETT BUSINESS LIC V#(REQUIRED):O4O59
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<br /> PRIMARY CONTACT: 0 OWNER El CONTRACTOR 0 OTHER(Please Specify) •
<br /> CONTACT NAME: Q CONTACT PHONE: 206-73 6-652M,
<br /> . J)1J14 ,}15 .IEDi/t/ CONTACT EMAIL: DNI'41S.raKOWa Ki i IT. C_'.oiY)
<br /> AGREEMENT,Thereby certify that I have read and examined this application and know the same to be true and correct. All provisions oflaw,s and ordinances governing this
<br /> type of work will be completed whether speciied 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!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 ROW and 298.200 WAG
<br /> City of Everett Official Use Only
<br /> FEE
<br /> PERMIT
<br /> Owner/Au orized Agen Signature Date (Revised 1O/12l2015)
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