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<br /> ELECTRIC, \L PERMIT ,APPLICATION ••
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<br /> CITY OF EVERETT PERMIT SERVICES
<br /> 3200 CEDAR STREET, EVERETT,WA 98201
<br /> (P)425-257-8810 I FAX 425-267-8857 I (E)everetteps@everettvva.gov I www.everettwa.govlpermits
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<br /> PROJECT ADDRESS: d ' z:
<br /> BUILDING AREA(if residential,new construction,remodel,or aditlon) SF
<br /> BUILDING TYPE: El SFR-DETACHED El SFR-ATTACHED El DUPLEX El MULTI-FAMILY-#OF UNITS: COMMERCIAL
<br /> USE OF BUILDING: r J4& El/EEL-Tr
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<br /> CONTRACT PRICE OF WORK:$ J/` ,500
<br /> NUMBER OF DEVICES(if low voltage):
<br /> FIRE ALARM? Ei YES 14 NO
<br /> ASSOCIATED BUILDING PERMIT#(if applicable):
<br /> DESCRIPTION OF WORK: t ' /��� 9/ / 6 ) r .
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<br /> OWNER NAME: TENANT NAME(if Commercial): ,' //06
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<br /> OWNER MAILING ADDRESS: STREET pa Eex 3707 •
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<br /> CITY .5EATTL�' STATE‘41-
<br /> M{//7 ZIF /g121/`.2207
<br /> OWNER PHONE: OWNER EMAIL:
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<br /> CONTRACTOR.NAME: 4, V -e_41, efP Z1 e..... ok)
<br /> CONTRACTOR ADDRESS: STREET Po &)X 4/p
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<br /> i)7)U/1 JL7gza aTATEIA14- zu�9�20`T'
<br /> CONTRACTOR PHONE:426-214`/e'1 CONTRACTOR EMAIL: ki-,a,• IMAMEi kiEW tr. c D
<br /> CONTRACTOR LCC.#(REQUIRED 6EAJ C(. 'LOz CITY OF EVERETT BUSINESS LIC.#!REQUIRED):0405,31._
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<br /> PRIMARY CONTACT: D OWNER 181 CONTRACTOR b OTHER(Please Specify)
<br /> CONTACT NAME: CONTACT PHONE: Zt -7 3 6-654-4
<br /> DgAi415 _&'W CONTACT EMAIL: ]r)ENA/[S.�.KQLtJ41:/Ew'►T. d. )M
<br /> AGREEMENT.T hereby certlfy that t have read and examined this application and know the same to be true and correct Ali provisions of laws and ordinances governing this
<br /> type of work will be completed whetherspecifed herein or not. The granting of pennit does not presume to give authority to violate or cancel the provisions of any other state or
<br /> local law regulating constructiorr or the performance of construction, That t am authorized by the owner of this property to perforin the work forwhich appitccatlon is made and I
<br /> comply with the State Contractors law 18.27 RCWand 296.20d WAC
<br /> City of Everett Official Use Only
<br /> FEE
<br /> 7g9
<br /> PERMIT#
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<br /> '13 E - Oc\3
<br /> Owner Au i or zed Agen Signature Date (Revised 10/12/2015)
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