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<br /> ELECTRICAL
<br /> PERMIT APP1rUC \TKON
<br /> CITY OF EVERETT PERMIT SERVICES
<br /> 3200 CEDAR STREET, EVERETT,WA 98201
<br /> (P)425-257-8810 j FAX 425-257-8857 (E)everetteps@everettwa.gov I www.everettwa.gov/permits
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<br /> PROJECT ADDRESS: ''D -2 /;/ e "' ee�
<br /> BUILDING AREA(If residential,new construction,remodel,or addition) SF
<br /> BUILDING TYPE: EI SFR-DETACHED El SFR-ATTACHED Cf DUPLEX Cl MULTI-FAMILY-#OF UNITS: /4 COMMERCIAL
<br /> USE OF BUILDING: gD,�G J4& E�j� TT
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<br /> :0.4',+., k�C_.;ino{{,b.t•L�.%:�ti'i',•.T.:+1i'L+c�t
<br /> CONTRACT PRICE OF WORK:$ 4 000
<br /> NUMBER OF DEVICES(if low voltage):
<br /> FIRE ALARM? 0 YES M NO
<br /> ASSOCIATED BUILDING PERMIT#(if applicable::
<br /> DESCRIPTION OF WORK: t1J s e , 11a 121 ?7 M L2
<br /> V. r wC,lDlrACT INF[3tfITON:,.. , •., _'
<br /> OWNER NAME: TENANT NAME(If Commercial): Ftel/J(b
<br /> OWNER MAILING ADDRESS: STREET Pp ,pox 57(8
<br /> crry STATE W/1- ZIFCMJ217L 2207
<br /> OWNER PHONE: OWNER EMAIL:
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<br /> CONTRACTOR.NAME: gl�tett C fJ/(-��7}ZG�(�r1G A-)
<br /> CONTRACTOR ADDRESS: STREET P,0
<br /> 9 & X 441
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<br /> CONTRACTOR PHONE:426 214'69 4? JCONTRACTOR EMAIL: kh-gi i-minm gickiwi. 6o'
<br /> CONTRACT OR T ie.#REQUIRED): ��_N IeC O z CITY of EVERETT DUSINESS LIC.#REQUIRED):040,5
<br /> PRIMARY CONTACT: El OWNER El CONTRACTOR~ El OTHER(Please Specify) -n
<br /> CONTACT NAME: p/ CONTACT PHONE: 2 -73O-(p 5449
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<br /> ) t 5 ( l D W CONTACT EMAIL: D6"_ Ai!S.6g.O4J® IC w—wh r. dOM
<br /> AGREEMENT.T hereby certify that I have read and examined this application and know the same to be true and contact. All provisions of laws and ordinances governing this
<br /> type of work wilt be completed whatherspecified herein or not. The granting of permit does not presume to give authority to violate or cancel the provisions of any other state or
<br /> focal law regulating construction or the performance of construction. That!am authorized by the owner of this property to perform the work for which application is made and!
<br /> comply with the State Contractors Law 18.27RCWand 296.204 WAG
<br /> City of Everett Official Use Only
<br /> FEE _
<br /> •
<br /> PERMIT#
<br /> A/14 A w � E `%bL - O`'1`A
<br /> Owner/Au or zed Agen Signature Date (Revised 10/12/2015)
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