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<br /> 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.gav I www.everettta.gov/permits
<br /> • O:D)f�0'�`•S�g`➢'E�• FORM_
<br /> PROJECT ADDRESS: - d j/Q ,62G L h.--a,
<br /> BUILDING AREA(If residential,new construction,remodel,of addition) SF
<br /> BUILDING TYPE: EI SFR-DETACHED D SFR
<br /> A-1TIAC-IED D DUPLEX El MULTI-FAMILY-#OF UNITS: MCOMMERCIAL
<br /> USE OF BUILDING: /D� G El/gee-Fr
<br /> �a'f+i,s..l .)1- _ .SIC.' 3.:• 3 .rr_yr .n��. •� e•), •,y:y.{n'7.��. •�..,
<br /> Y'1TR[ A•L''A� �//'�� s3i►�^M -OR��.(.�.(,pj..j�„�T�OI�:��• `,: :�',:.,:,i, •:,�¢5:,
<br /> ti�4.•`.:., .. ,rl.:s t.a•._.�.•i..V.+t... ....,_:Y• .:Y:.•.v.At.< sa's,+.!FFA•,.hcl'�S'":c.�j•,.. � lam•.-•..• 4e:.•rR .t. i. _ }, '�!' r'ti. , 7'i•:.' i.t.
<br /> ":,•,••••• `•,'','” ••••• •:'• ,'•:' 4'ten-s ,hu•i,J• .•- :.1�'P:N1;•11'r:ReV:{t 4a...iw. 6 5 sT-,•,'st t':•.�.
<br /> CONTRACT PRICE OF WORK;$ ;,c2e:)
<br /> •
<br /> NUMBER OF DEVICES(if low voltage):
<br /> FIRE ALARM? D YES /4 NO
<br /> • E
<br /> ASSOCIATED BUILDING PERMIT#(If applicable):
<br /> DESCRIPTION OF WORK: /2 'Ag%(/'f/if� 4)aa,/9 /26(1Q /d0
<br /> •
<br /> • ..:..,.�.. :,... . •• - _. .... . • �O1I�NAC71N)FORIV�A7101�:. .. _ -. � .�,� _> '• .,
<br /> OWNER NAME: TENANT NAME(If Commercial): bt)6
<br /> OWNER MAILING ADDRESS: simgv Pa Pox 3707
<br /> cm( .5 1.7TLk STATE / z /f/2 -22O7
<br /> OWNER PHONE: OWNER EMAIL:
<br /> ♦u ♦ &V t •d .a• F —3 a.� y ,._r . ♦ f2 IJV Ju f♦•tJ. •♦.mow a. t. a ♦ 1 •.♦ •. , ♦_ t • u ♦ u .r. •rV. , ,. . . .. . f
<br /> CONTRACTOR NAME: C. j) , -L,
<br /> CONTRACTOR ADDRESS: STREET PQ Sox 4/'
<br /> csrrSTATEVVi}- ZIP @g2,04
<br /> CONTRACTOR PHONE:426-214-691714 CONTRACTOR EMAIL: k '�f. iminmE-f tip �'W/?', CO/7)
<br /> CONTRACTOR LIC.#(REQUIRED): 66N gC $14o Z, CITY OF EVERETT E USINESSL1C.#(REQUIRED):04105.11,-.
<br /> PRIMARY CONTACT: 9 OWNER ll CONTRACTOR CI OTHER(Please Specify)
<br /> CONTACT NAME: p f CONTACT PHONE: 2 p(p-73 6-654.4
<br /> . DC/kJ!4 C s 6iCONTACT EMAIL: DENA' S.LI gat/ k i w iT. 60I'Y)
<br /> AGREEMENT T hereby certify that I have read and examined this application and knowihe same to be true and correct. All provisions of laws and ordinances governktg this
<br /> type of work will be completed whether specified 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 regulafng construction or the performance of construction. That!am authorized by the owner of figs property to perform the work for which appk-cation Is made and!
<br /> comply with the State Contractors Law 18.27 ROW and 298.20d WAG
<br /> City of Everett Official Use Only
<br /> FEE
<br /> • °925. 0
<br /> •
<br /> PERMIT#
<br /> E B04- 10*
<br /> OwnerlAu or zed Agen Signature Date (Revised 10/12/2015)
<br />
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