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09/12/2017 13: 27 #2597 P. 001/001 <br /> /W— ELECTRICAL PERMIT AIAPLICATION <br /> 111111.1` ', 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 1 www.everettwa_gov/perrnits <br /> PROJECT ADDRESS: ( <br /> BUILDING AREA(if residential,new construction,remodel,or addition) SF <br /> BUILDING TYPE: I 1 SFR-DETACHED d SFR-ATTACHED 0 DUPLEX 0 MULTI-FAMILY-#OF UNITS: EreOMMERCIAL <br /> USE OF BUILDING: JY`� .' t PI/V2r-titiG L <br /> CONTRACT PRICE OF WORK:$ ,014110 <br /> NUMBER OF DEVICES(if low vo f-.e): <br /> FIRE ALARM? ❑YES 0 • <br /> ASSOCIATED BUILDING PERM 'livable : <br /> DESCRIPTION OF WORK: gi)g)ti, /Rt'L-4ec put mime._ fig, 5Lo <br /> f A T J III C,4& PAAk.1 A'!a -A-h <br /> Av 71h, / d K.. B Lett yt <br /> OWNER NAME: TR Ur,k[. eAneL1 or 7 NANT NAME(If Cammareial) A <br /> OWNER MAILING ADDRESS: smaur 3e. �/4 ' • t�, <br /> CITY t�� ' / STATE 1�r, _ 04 <br /> OWNER PHONE: -11193 OWNER EMAIL: <br /> CONTRACTOR NAME: a'd_.e ,/!1L I ft D <br /> CONTRACTOR ADDRESS: sines ice I . 1 e 49- <br /> CITY E7STATE 1.414( <br /> CONTRACTOR PHONE: • :A '�I ,z . / CONTRACTOR EMAIL: L_' <br /> CONTRACTOR LIC.#(REQUIRED: 1,4 A s / CITY OF EVERETT BUSINESS LIC.#(REQLDRE: <br /> PRIMARY CONTACT: CI OWNER • CONTRACTOR MOTHER(Please Specify) . ;„�_ <br /> CONTACT NAME: CON • V .23/ <br /> 71ti14A.t°0611 <br /> U1 <br /> CONTACT EMAIL: nil' <br /> AGREEMENT;l hereby centy that I have read and examined this application and know the same tube true and correct. All provisions of laws and ordinances'goveming INS type <br /> of work will be completed whether specified herein or not. The granting of a permit does not <br /> presume�gNe authority to violate or cancel the provisions of any other state or <br /> local taw regulating construction or the performance of construction. That l am authorized by the owner of this property to perform the wore for which application Is made and <br /> comely WIth the State Contractors Law 1a27 RCW and 296.200 WAC <br /> • <br /> City of Everett Official Use Only <br /> / PERMIT# <br /> ./ !2 E \ ?-o9 -`'V S R. <br /> Owner/ �'zed Agent Signature Data (Revised 923/2016) <br />