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LECTRIICAL PERMIT AP bCATION
<br /> CITY OF EVERETT PERMIT SERVICES
<br /> 3200 CEDAR STREET, EVERETT, WA 98201
<br /> (P)425-257-8810 I FAX 425-257-8857 I (E)everetteps@everettwa.gov I www.everettwa.gov/permits
<br /> • '010,400T SITE 9N1F0R T1(r. ;.:. ..
<br /> PROJECT ADDRESS: ht' 10 k, 5
<br /> BUILDING AREA(if residential,new construction,remodel, or addition) SF
<br /> BUILDING TYPE: SFR-DETACHED ❑SFR-ATTACHED 0 DUPLEX Cl MULTI-FAMILY-#OF UNITS: 0 COMMERCIAL
<br /> USE OF BUILDING: Giretell.e.,
<br /> •ELECTRICAL APPIAUCATION INFORMATION
<br /> CONTRACT PRICE OF WORK:$ -75-04s')
<br /> NUMBER OF DEVICES(if low voltage):.
<br /> FIRE ALARM? ❑YES ,240
<br /> ASSOCIATED BUILDING PERMIT#(if applicable): p Q
<br /> DESCRIPT�OF WORK: bd�Ct e�°c-) �- �l s I ��_1 R-LU c £f%5 1
<br /> Lci
<br /> CmNT1 CT7NF®RMATIAN.
<br /> OWNER NAME: S kfut fr—e6K{ TENANT NAME(If Commercial):
<br /> OWNER MAILING ADDRESS: STREET \'l
<br /> CnY y � STATE ZIP
<br /> OWNER PHONE: \--Vis' rnrnl([.7 ? OWNER EMAIL:
<br /> CONTRACTOR NAME: 1,1 . YL Y"A vi ccs ( /) L
<br /> CONTRACTOR ADDRESS: STREET c2CI,e[° l �� t lay'`} �( G
<br /> CITY (da Vl STATE L„)�4- ZIP v Z `
<br /> CONTRACTOR PHONE: L(2.5 3¢te 45SD CONTRACTOR EMAIL:
<br /> CONTRACTOR LIC.#(REQUIRED): X/1 61T7 0c CITY OF EVERETT BUSINESS LIC.#(REQUIRED):OS-3 q77OS-3q
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<br /> PRIMARY CONTACT; ❑OWNER 0 CONTRACTOR OTHER(Please Specify)
<br /> CONTACT NAME: CONTACT PHONE: L 35-3 7162 [
<br /> 1,141)0443 CONTACT EMAIL:
<br /> AGREEMENT:T hereby certify that 1 have read and examined this application and know the same to be true and correct. All provisions of laws and ordinances governing 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 regulating construction or the performance of construction. That lam authorized by the owner of this property to perform the work for which application is made and 1
<br /> comply with the State Contractors Law 18.27 RCW and 296.200 WAC.
<br /> City of Everett Official Use Only
<br /> FEE
<br /> PERMIT#
<br /> (-71( ll7
<br /> Own tho!zed Age/4 ignature Date (Revised 10/12/2015)
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