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ELECTRICAL PERMIT APPLICATION
<br /> 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 wvvw.everettwa.gov/permits
<br /> 1rf.,4R:
<br /> F1132252L,ETIEIIL/2223. jf„ 'E, . e
<br /> BUILDINGAREA Of residential,new construction,remodel,or addion) SP
<br /> BUILDING TYPE: p6FR-DETACHED 0 SFR ATTACHED 0 DUPLEX 0 MULTI FAMILY-#OF UNITS: 0 COMMERCIAL
<br /> , -
<br /> USE OF BUILDING:
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<br /> rclx''41:,-
<br /> ... ,.......,.... ,,„. ........,.........- ,...,4 , ....,,,z„, . . .it', •...4< ,,,,,.
<br /> CONTRACT PRICE OF WORK: $ • . 0
<br /> NUMBER OF DEVICES if low voite.e:
<br /> - ,
<br /> FIRE ALARM? 0 YES A NO
<br /> ASSOCIATED BUILDING PERMIT# if-0.licabIe'
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<br /> .•
<br /> ik.
<br /> !,11,7i;LI
<br /> $1t
<br /> OWNER NAME , ri irA - TENANT'N''"AM:'.E4 t{fo:r8,em11f.'f"it,k\,ero'.t'0"s'tit1
<br /> 1? .9-.7.6 /4 1,,,„.„Cf - ,d.fry'
<br /> OWNER MAILING ADDRESS: STREET 44.0 0 %go,1 tori T nr,‘,16.0
<br /> CITY O.A :04," - STATE ZIP
<br /> OWNER PHONE. • e"0 45 500,..- ovvtioR EMAIL: ,
<br /> CONTRACTOR NAME CrA t1,31-041-0-9
<br /> CONTRACTOR ADDRESS: STREET 1 Li r5 lar0 C‘j ' '
<br /> cm( 4 ' - ' ' -• dit ..,,,,,,-,
<br /> STATE ZIP 0 40.4.,
<br /> C0/4101'014 PHONE -t. , Ikilso 0 4P CONTRACTOR EMAIL: 'LitVS6 0 9 afyitiepairt a ce)rvi
<br /> 'coil 1 mama Lio.#moutREty:cril Al ritag::tr,,vite-ai CllY.!I a. 717--VilaiNftS 140,4 REOLIM s , 1 siirTitiCe6 44*---- --'
<br /> PRIMARY CONTACT: •0 OWNER ACONTRACTOR 0 OTHER(Please Spedify); --------.-------
<br /> ' •,
<br /> CONTACT NAME:
<br /> CONTACT PHONE
<br /> 4 ,,. CONTACT,EMAIL: debk :: Ocittyllett44r8 .cern
<br /> VelcAale
<br /> AGREEMENT.I hereby certify that I have read and examined this application and know the same to be true and correct. All provisions of laws and ordinances governing this type
<br /> of work will be.completed whether specified herein or not. The granting ata 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!am authorized by the owner of this property to perform the work for which application is made and!
<br /> comply with the State Contractors Law 18.27 ROW and 296.200 WAC.
<br /> .
<br /> City of Everett Official Use Only '
<br /> PERMIT#
<br /> , .A:1,-11,14.., OP ,
<br /> , VAI" ' 'al ' ' ' ' 7.13'1C3 E 0 -O2_0
<br /> ownerauthertzeg Agent Signakure bate (Revised 9/23/2016)
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