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ELECTRIC;►;,IL 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 wUwv.everettwa.gov/permits
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<br /> PROJECT ADDRESS: 1-(0- ,t k1(! c-c c( (,�. ''!
<br /> BUILDING AREA(If residential,new construction,remodel,or addition SF •
<br /> BUILDING TYPE: D SFR-DETACHED D SFR ATTACHED 0 DUPLEX ❑MULTI-FAMILY-#OF UNITS: M COMMERCIAL
<br /> USE OF BUILDING: OE L 4t EVE '-T”
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<br /> CONTRACT PRICE OF WORK:$ t' 17 C
<br /> NUMBER OF DEVICES(if low voltage):
<br /> FIRE ALARM? CI YES NO
<br /> ASSOCIATED BiJILDING PERMIT#(if ap licable):
<br /> DESCRIPTION OF WORK: j 'Y`j . 10 W L.li(e � hos
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<br /> a_ .`. -i . . s.. .-_';_ .CONT,..91 JNFOR1417"ION. , - :•_ w
<br /> OWNER NAME: TENANT NAME(if Commercial): B"pt...)G
<br /> OWNER MAILING ADDRESS: mem. P7 X 57i)7
<br /> cm' 450177"l E urns / zicJl241-2267
<br /> OWNER PHONE: OWNER EMAIL:
<br /> CONTRACTOR NAME: a'- l) ttz,. I0,5 jeu... iat.
<br /> CONTRACTOR ADDRESS: amsar Po gox 41, {, {Q ,+�L�4/
<br /> COY Ina'g 11.72 ) srAAElfV,/ zie Ff 2Z3 L
<br /> CONTRACTOR PHONE:426-294-61 44 'CONTRACTOR EMAIL: kA"j1• / k'/ 'W/7 e SCO
<br /> CONTRACTOR LIC.#(REQUIRED): �1� /�C `7 Q z CITY OF EVERETT EtUSI�NESS LIC.#(REQUIRED):0405't
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<br /> PRIMARY CONTACT: D OWNER lel CONTRACTOR 17 OTHER(Please Specify)
<br /> CONTACT NAME: • CONTACT PHONE: 2O4•-73 --(p5AM,
<br /> • I) 'I'I1115 £leDW CONTACT EMAIL: DERj14I .e gUk)1 kI l/t/ti1. dory)
<br /> AGREEMENT:T hereby certify that t have read and examined this application and know the same to be true and correct. All provisions ofiaws and ordinances governing this
<br /> type of work wNlbe completed whelherspecified herein or not. The granting of a permit does not presume to give authority to violate or cancel the provisions of any other slate or
<br /> local law regulating conslrucUonortheperformance ofconstruction. That!am authorized by the ownerof this property to perform the work for which appilcation Made and I
<br /> comply with the State Contractors Law 18.27 RCW and 296.20d WAC.
<br /> City of.Everett Official Use Only
<br /> FEE
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<br /> PERMIT#
<br /> 141.1/ E 1 (605- U-15 '
<br /> Owner/Au or zed Agen Signature Date (Revised 10/12/2015)
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