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ellpili-- ___ tLECTRII AL PE MIT APPLICATION
<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 a@everettwa.gov I www.everettwa.gov/permits
<br /> . • PR tiJECT SITE NFORMAT Old` ` - ..
<br /> PROJECT ADDRESS: / S O7 I. Pi g",,,
<br /> BUILDING AREA(if residential,new construction,re *del, or addition) A14,14,,or pwl SF ."`_
<br /> BUILDING TYPE:CSFR-DETACHED 0 SFR-ATTACHED 0 DUPLEX 0 MULTI-FAMILY-#OF UNITS: 0 COMMERCIAL
<br /> USE OF BUILDING: 0: 1Z:;)SGC/G"� •
<br /> IELJ CTRIC.AL APPUICAltial INIP®RMA i#N..
<br /> CONTRACT PRICE OF WORK:$ Jho d
<br /> NUMBER OF DEVICES(if low voltage):
<br /> FIRE ALARM? 0 YES ped0
<br /> ASSOCIATED BUILDING PERMIT#(if applicable): y�
<br /> DESCRIPTION OF WORK: /g s/Z i , 712 - -ge, Q t- rQ 7c..,
<br /> --, - - - -- , - NTA, T;INFORMATION..
<br /> .
<br /> OWNER NAME: . clC.. 4---trna fl TENANT NAME(If Commercial):
<br /> OWNER MAILING ADDRESS: STREET ) j Ho " ` \�h 4'iG / -
<br /> v4-72-7 - CITY / AL(.5A
<br /> A �Z'
<br /> � ZIP� 3
<br /> OWNER PHONE: `L_S Z/3 T 6. sb cOWNER EMAIL:
<br /> CONTRACTOR NAME: e„.6,/�j7 1r ©a GjC,14F., I -2,
<br /> CONTRACTOR ADDRESS: STREET I ?j 72-2 £-'/ 1(a RP
<br /> 4444,8-02 CITY STATE cc,,,— ZIP 9 k•
<br /> CONTRACTOR PHONE: v e La
<br /> CONTRACTOR/� EMAIL: J e1 or,s-----ca 4-a#7,92-
<br /> CONTRACTOR LIC.#(REQUIRED):1..,�S7ZOrc i
<br /> 44l 4 f CITY OF EVERT Bk1 INESS LIC.#(REQUIRED): 7r
<br /> �
<br /> n....,.R.�,::.-,___-„>..�..r,,..�-<,.c n_:_....,.,...�r��..y,_�r,r.-__.:.:_....�s_-�__.��_..._.._n_M.:.,.•,r�..,.,,,-s.�.........:.....T:..<,...�,y._�_,...,.�._:�._,..<�..,��_-.,.,.M.
<br /> PRIMARY CONTACT: VOWNER 0 CONTRACTOR 0 OTHER(Please Specify)
<br /> CONTACT AME: CONTACT PHONE:
<br /> �J� h f i CONTACT EMAIL:
<br /> AGREEMENT:T hereby certify that 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 whet er 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 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 98.27 RCW and 296.200 WAC.
<br /> City of Everett Official Use Only
<br /> FEE
<br /> PERMIT*
<br /> 4/#' i ia , E ( SO I - 001
<br /> Ow. •rized Agent Signature Date (Revised 10/92/2095)
<br />
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