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014' E CTRICAL PERMIT APPLTCATI
<br /> CITY OF EVERETT PERMIT SERVICES i '
<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
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<br /> PROJECT ADDRESS , / • \ 2.1)BUILDING AREA(if residential,new construltion,remodel,or addition) (Z15)(, ,Yrh fj SF
<br /> BUILDING TYPE:I,'S'FR-DETACHED 0 SFR-ATTACHED 0 DUPLEX 0 MULTI-FAMILY-#OF UNITS: 0 COMMERCIAL
<br /> USE OF BUILDING:
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<br /> CONTRACT PRICE OF WORK:$ Q
<br /> NUMBER OF DEVICES (if low voltage):
<br /> FIRE ALARM? 0 YES 0 NO
<br /> ASSOCIATED BUILDING PERMIT#(if applicable):
<br /> DESCRIPTION OF WORK: Ll\LQ, Ovid 11--IIT `47t'lc z ?V)/ ' -'
<br /> VIC�
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<br /> im,ill;i 'VA slf',. kM" in T a.r,' " ,b P.( TA,F ii�U' �A IO� &I�(�!!!I IIIII�IIIIIIIIIilli� of k'�I�� k?; .s4 x^ 2`'', xr,.R",'. -I I
<br /> EU IN Ui ,axle tiu iI n i "
<br /> OWNER NAME:PO()Una (i) I fe, TENANT NAME(If Commercial):
<br /> OWNER MAILING ADDRESS: STREET/ /�veil-07 Cfa(A,1 !D
<br /> CITY r1Y 'STATEIj�, /���/1� ZIP�jj%��
<br /> OWNER PHONE: 40--- I - 7.91,o, OWNER EMAIL:P t C USIA (L)iJ i i - W/ , !�'r! v ���JJJ
<br /> CONTRACTOR NAME: -ril ,e room
<br /> CONTRACTOR ADDRESS: STREET`Ill in .7,1A-111I/(�+ ,3/,(J /] f�
<br /> CITY 14001+0 1 `? vaie_ ZIP g —13
<br /> CONTRACTOR PHONE:L 1 — 3 CONTRACTOR EMAIL: d
<br /> � �7 , 7� iii-rd obe,,„n,,,,„,-f,cwy?
<br /> CONTRACTOR LIC.#(REQUIRED):1Lee P CITY OF EVERETT BUSINESS LIC.#REQUIRED: -]
<br /> PRIMARY CONTACT: 0 OWNER 'CONTRACTOR 0 OTHER(Please Specify)
<br /> CONTACT NAME:
<br /> 0-(vric,, CONTACT PHONE: ,Lfi y, — 1 1 _....*- 1 X17 /► ��/�� }(�/�� /1 ,�/�i M 11 ,l ) Y 1 - CONTACT EMAIL: (►Y`J 0 & /l/p. Il`�/ , poi I / J'0 f / OI i 'AGREEMENT..T hereby certify that I hd ex-yned 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•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 I am authorized by the owner of this property to perform the work for which application is made and I
<br /> comply with the State Contractors Law 18.27 RCW and 296.200 WAC.
<br /> City of Everett Official Use Only
<br /> FEE
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<br /> 4? „.�
<br /> PERMIT
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<br /> Ai TA 5-11 8 E ()2j02;/
<br /> Owner!,4 d Agent Signature W Date (Revised 10/12/2015)
<br />
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