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A 225- z��,�'�73�) <br />ELECTRICAL PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />(P) 425-257-8810 1 FAX 425-257-8857 1 (E) everetteps@everettwa.gov I WWW.everettwa.gov1permits <br />Offl, 049"T <br />Al &&d4;ff4 <br />PROJECT ADDRESS. ra <br />BUILDING AREA (if residentlal, new construction, remodel, or a'huon) <br />SF <br />BUILDING TYPE: 1JSFR-DETAGHr=D 13SFR-ATTACHED EIDUPLEX <br />El MULTI -FAMILY -#OF UNITS: COMMERCIAL <br />USE OF 13U, ILI& E�- <br />BUILDING: gQg <br />"J" <br />CONTRACT PRICE OF WORK: $ <br />NUMBER OF DEVICES (if low voltaqa).- <br />FIRE ALARM? LI YES NO <br />ASSOCIATED BUILDING PERMIT # (if applicable): <br />DESCRIPTIO OF WORK: <br />AA4_-,j 2�g <br />............ . <br />------------------------------ <br />OWNER NAME: TENANT NAME (if Commercial): <br />OWNER MAILING ADDRESS: mEr=-r 90)(M2 <br />orty STATE i&12j1- 22,07 <br />OWNER PHONE; .,.....[OWNER <br />EMAIL' <br />CONTRACT 7 7 <br />CONTRACTOR ADDRESS: sraz r PO ewx <br />C17Y LTAA4Z* <br />CONTRACTOR PHONE: 426-2q4 -IH44 jCONTRACTOR EMAIL - <br />CONTRACTOR LIG. W(REQUIRED): 66A16eC 2fq07 -- CITY OF EVERETT OUSINESS LIG. #(REQUIRED):00522 <br />PRIMARY CONTACT., 0OWNER 14CONTRACTOR 0 OTHER (Please Specify) <br />CONTACT NAME: <br />' Dl'mq 1,5 1CONTACT <br />GO TACTPHONE-. <br />EMAIL; IDS LIN 19.6ADWO <br />/4 WKtt:jWt:1V 1. 1 nerepy Garripl mar I nave road and examined <br />this appilcation and knowthe same to be true and correct. All provisions of laws and ordinanca.5 governing this <br />type of work will be completed whetherapacifled herein ornot The granting ofpermit does not presume to give autharkyto violate or cancel the provisions of any other state or <br />locallaw regulating construction or the pefformance of construction. That I am authorized by the owner of thisprapaily to perform the work for which appikatlon Is made and I <br />comply with the State Contractors Law 18.27 RGW and 296.20d WAC. <br />ZOwner 1A!#'r1zed Aaenfbignature Date <br />City of Everett Offiblal Use Only <br />FEE <br />PERMIT# <br />E ke�—�O — <br />(Revised 10/12,2015) <br />