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• 2 25- 2957 47,9. 7
<br /> ELECTRICAL PERMIT APPLICATION
<br /> CITY OF EVERETT PERMIT SERVICES •
<br /> 3200 CEDAR STREET, EVERETT,WA 98201
<br /> (P)425-257-8810 E FAX 425-257-8857 (E) everetteps@everet(wa.gov www.everettwa.gov/permits
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<br /> PROJECT ADDRESS: "
<br /> BUILDING AREA(if residential,new construction remodel, addition) SF
<br /> BUILDING TYPE: El•SPR DETACHED ID SFR-ATTACHED El DUPLEX EI MULTI-FAMILY-#OF UNITS: COMMERCIAL
<br /> USE Ol"BUILDING: Q 1J 4 , �1�>r,e�77" •
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<br /> CONTRACT PRICE OF WORK:$ 5,,616)0
<br /> NUMBER OF DEVICES if low voltage):•
<br /> FIRE ALARM? fl YES 14 NO
<br /> ASSOCIATED BUILDING PERMIT#(if applicable): •
<br /> DESCRIPTION OF WORK: R.6 .107-198.4&5 /A/ ei /s 7
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<br /> OWNER NAME: TENANT NAME(if Commercial): $CEfit.}!j
<br /> OWNER MAILINGADDRESS: smear Po , ,ox 3707 •
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<br /> OWNER PHONE: OWNER EMAIL:
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<br /> CONTRACTOR NAME: gr} , e_a_AS tie... '/0/0
<br /> CONTRACTOR ADDRESS: emu Po Sox 41, /
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<br /> CONTRACTOR PHONE:426"2q4-6/1/14 CONTRACTOR EMAIL: belle/. H.+ 1nhl '' g& l 14/1 r. &)/t.1
<br /> CONTRACTOR LIC.#(REQU1RED): a•E1lfri8 !4'j Q,Z CITY OF EVERETT ElUSINESS Lie.#(REQUIRED):04405 .��
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<br /> PRIMARY CONTACT: El OWNER CONTRACTOR El OTHER(Please Specify)
<br /> CONTACT NAME: nn +,t CONTACT PRONE: 206.-73 6-15 o
<br /> • ��lY 141 £J 1)U� CONTACT EMAIL: DEN Nig. ..l2,01.4l Ti.L UI/ti T.
<br /> AGREEMENT T hereby cartify that i have read and examined this application and lalow the same to be true and correct Al 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 am authorized by the owner of this properly to perform the work for which application is made and
<br /> comply with the State Contractors Law 18.27 RCW and 298.20d WAC.
<br /> City of Everett Oificlal Use Only
<br /> FEE 344 `J-0 _.
<br /> PPECERMIT# l
<br /> I ?)015-
<br /> Owner/Au 1 or zed Agent SIgnature Date (Revised 10/12/2016)
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