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ELECTRICAL PERMIT A PPLICA It ION •
<br /> CITY OF EVERETT PERMIT SERVICES
<br /> 3200 CEDAR STREET, EVERETT,WA 98201
<br /> (P)428257-8810 J FAX 425-257-8857 I (E)everetteps ct7r everettwa.gov J www.everettwa.govlpermits
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<br /> PROJECT ADDRESS: Lt 0-2--LA • ?Ai,\ .k\elo • f) 1 (o
<br /> BUILDING AREA(If residential,new construction,remodel,or addition) SF .
<br /> BUILDING TYPE: ❑'SFR DETACHED ❑SFR`ATTACHED ©DUPLEX El MULTI-FAMILY-#OF UNITS:, COMMERCIAL
<br /> USE OF BUILDING: �06.1V46 EVE,,PETT
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<br /> CONTRACT PRICE OF WORK:$ `133Qo
<br /> NUMBER OF DEVICES(if low voltage):
<br /> FIRE ALARM? , ❑YES 3J NO
<br /> ASSOCIATED BUILDING PERMIT#(if applicable): •
<br /> DESCRIPTION OF WORK: c`s • ° r 6 1s"' `z"_�k'':.> 4�!=u f • k .s Too t:$
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<br /> OWNER NAME: TENANT NAME(if Commercial): BCE/106
<br /> OWNER MAILING ADDRESS: STREET PO Eie3X 37o7
<br /> ern' .501771E E STATE WA- 21 /g/2q 22°7
<br /> OWNER PHONE: OWNER EMAIL:
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<br /> CONTRACTOR NAME: ( ,V le& o..)57- /•_G e....- / t)
<br /> CONTRACTOR ADDRESS: smseryy/�`�OQ Box
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<br /> CIM /7/t/['�/GJ.IIL) 7 2 STATE * ZIP9g261-1
<br /> CONTRACTOR PHONE:4_25"2/4-7��4i f CONTRACTOR EMAIL: kA-1 ,). Hitin/nErJ2ep &)f)
<br /> CONTRACTOR LIC.#(REQUIRED): � ��'C �D CITY OF EVERETT BUSINESS LIG.#(REQUIRED):041D. man
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<br /> PRIMARY CONTACT: ❑OWNER K CONTRACTOR El OTHER(Please Specify)
<br /> CONTACTNAME: . !,f CONTACT PHONE: 204)-"736-654-0,
<br /> Di)(Ai 15 C CONTACT EMAIL: DENS iS,e,gQLtl® kik-MT. &OXY)
<br /> AGREEMENT:T hereby certify that have mad and examined this application and know the same to be true and correct Afi provisions of laws and ordinances governing this
<br /> type of work Mae completed whether specified herein or not The granting of a permit does not presume to give authority to violate orcancei 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 I
<br /> comply with the State Contractors Law 18.27 RCW and 298.20d WAC.
<br /> City of Everett(kale!Use Only
<br /> FSE S D
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<br /> PERMIT E , ���� e
<br /> 1/
<br /> Owner/Au ortzed Agen'Signature Date (Revised 10/12/2016)
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