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<br /> CTRICAL PERMIT APICATIOIN
<br /> CITY OF EVERETT PERMIT SERVICES
<br /> 3200 CEDAR STREET, EVERETT,WA 98201
<br /> (P)425-257-8810 I FAX 425-257-8857 ( (E) everetteps@everettwa.gov I www.everettwa.gov/permits
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<br /> PROJECT ADDRESS 23 z o C 4, 1 t-c.04 w ek S4-e-ee Ar-
<br /> BUILDING AREA(if residential,new construction, remodel,or addition) /ODO SF
<br /> BUILDING TYPE: 0 SFR-DETACHED 0 SFR-ATTACHED 0 DUPLEX 0 MULTI-FAMILY-#OF UNITS: COMMERCIAL
<br /> USE OF BUILDING: OCCl‘,.....< J ‹u.0
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<br /> CONTRACT .
<br /> PRICE OF WORK: $ 1 ”00 f)'
<br /> NUMBER OF DEVICES (if low voltage):
<br /> FIRE ALARM? ❑YES (5(410
<br /> ASSOCIATED BUILDING PERMIT#(if applicable):
<br /> DESCRIPTION OF WORK: /eitc,. - ��QrOfNe, eq,,4 '4 eta ���
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<br /> OWNER NAME: ,s-,,.. p,,,,
<br /> TENANT NAME(If Commercial): Sino p
<br /> OWNER MAILING ADDRESS: STREET 2_r7 Z c H�
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<br /> CITY �C:.i,, ,t G, :STATE"'. ZIP fee:MI
<br /> OWNER PHONE: Tom- 703 /e)00 OWNER EMAIL:
<br /> CONTRACTOR NAME: 13+f Z'v..,K k�.e...4-,(l%c„.,
<br /> CONTRACTOR ADDRESS: STREET (Z,,,t 0 Li - w /Y/ ,,r- e..
<br /> CITY icir f 4/4. STATE Z. 4 ZIP 9r�o3.
<br /> CONTRACTOR PHONE: 42..r 7 (p 47Op_C ONTRACTOR EMAIL: d4�,��; v,h�eL.,. {tG.,4,
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<br /> CONTRACTOR LIC #(REQUIRED)5f.,1%/444. $gtOP/4, CITY OF EVERETT BUSINESS LIC #(REQUIRED).
<br /> PRIMARY CONTACT: 0 OWNER ONTRACTOR 0 OTHER(Please Specify)
<br /> CONTACT N E: CONTACT PHONE: 4y 7g 6 7 0 i&
<br /> �I� � r Kielce
<br /> t. 1 " .e, ` CONTACT EMAIL: c,... Q hf,m Ct}G % cwt
<br /> AGREEMENT:I 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 type
<br /> 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 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 /> PERMIT#
<br /> 0,,g: ,Owner/Authoriz d Agent Signature Date (Revised 9/23/2016)
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