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<br /> ELECTRICAL PCS MIT APPUUCAT(• ( 3i , J .
<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@everettwagov I www.everettwa.gov/permits
<br /> PROJECT ADDRESS: p .4 �/ i/t �� � ` :�'
<br /> BUILDING AREA(if residential,new construction,rem•'I,or addition) SF
<br /> BUILDING TYPE: ©SFR-DETACHED C7 SFR ATTACHED ❑DUPLEX El MULTI-FAMILY-#OF UNITS: NJ COMMERCIAL
<br /> USE OF BUILDING: A:0E1KtG EVEi TTT
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<br /> CONTRACT PRICE OF WORK:$ ,,LDS
<br /> NUMBER OF DEVICES(if low voltage):.
<br /> FIRE ALARM? El YES liq NO
<br /> ASSOCIATED BUILDING PERMI (if applicable):
<br /> DESCRIPTION OF WORK: *61/)27-51,0 Gv 0E00/ - 2 Q1142e
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<br /> OWNER NAME: TENANT NAME(If Commercial): fL.)G
<br /> OWNER MAILING ADDRESS: smear PC? ��.GX 3707
<br /> onv t5E I t g. STATE /4 ZI1'2fI29 2207
<br /> OWNER PHONE: OWNER EMAIL:
<br /> CONTRACTOR NAME: 4 ifier57 eG1L�7"/0.4)
<br /> CONTRACTOR ADDRESS: sTsser Pa f3OX 44, a p�j
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<br /> CONTRACTOR PHONE:4z /1
<br /> 2/4^6944 CONTRACTOR EMAIL: /fia/. Htt/f)MEie4kik-VW T. &)IY)
<br /> CONTRACTOR LIC,#( ,+.
<br /> REQUIRED): ��il��l� O Z CITY OP EVERETT BUSINESS.r.r,.n...o LIC.#(REQUIRED):o4d5 .�
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<br /> PRIMARY CONTACT: ❑OWNER SSI CONTRACTOR El OTHER(Please Specify) •
<br /> CONTACT NAME: p CONTACT PHONE: 204.-'73 O 454.4, .
<br /> ,D10415 Ceoul CONTACT EMAIL: DENN1S. ,-okJ a kiE'wVIT, e_oM
<br /> AGREEh1F_Ni T hereby certify that/have read and examined this application and know the same to be true and correct All provisions of laws end ordinances governing this
<br /> type of work will be completed whetherspecified herein or not. The granting of a permit does not presume to Om authority to violate or cancel the provisions of any other state or
<br /> local taw regulating construction or the performance of construction. That fam authorized by the owner of this propertyfo perform the work for which application is made and I
<br /> comply with the State Contractors Law 1a27RCWand 298.20d WAC.
<br /> City of Everett Official Use Only
<br /> FEE �� �
<br /> di /303
<br /> PERMIT#
<br /> ,/ 4 -/9-1S/ E kS6k--( x, (0
<br /> Owner/A orized Agen Signature Date (Revised 10/12/2015)
<br />
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