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ELECTRICAL *ERNNI APPLICATION •
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<br /> ' CITY OF EVERETT PERMIT SERVICES
<br /> 3200 CEDAR STREET, EVERETT, WA 98201
<br /> (P)425-257-8890 1 FAX 425-257-8857 1 (E)everetteps@everettwa,gov 1 www.everettwa.govlpermifs
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<br /> PROJECT ADDRESS: L/0-J- �k,)(.( i c`i�. (I L.0 krill") J -'
<br /> BUILDING AREA(if residential,new construction,remodel,or addition SF '
<br /> BUILDING TYPE: 0 SFR-DETACHED El SFR ATTACHED 0 DUPLEX 0 MULTI-FAMILY-#OF UNITS: (COMMERCIAL
<br /> .1222.2.F.,BUILDING: a,,,,.._...
<br /> (gelI & E VEPErr
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<br /> CONTRACT PRICE OF WORK:$ 'S t OO '
<br /> NUMBER OF DEVICES(if low voltage):
<br /> FIRE ALARM? D YES RI NO
<br /> ASSOCIATED BUILDING PERMIT#(if applicable):
<br /> DESCRIPTION OF WORK: � --> ri c: t 1 it i (0 Cx:t?—"'l' 1 TbO L
<br /> • ,O[1>f .O.K07 .40.0 NlATlOi t:::' . ." , -::...-;..:,..7.-.:',..-.`-' - ..f
<br /> OWNER NAME: TENANT NAME(if Commercial): BCE/1136
<br /> OWNER MAILING ADDRESS: STREET pa l x 3707
<br /> •
<br /> MN :5 1-TrLE STATE 1/1//4- zJ9 /24-2247
<br /> OWNER PHONE: OWNER EMAIL:
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<br /> CONTRACTOR NAME: ( :ejeft, iv5neue..770.4.)
<br /> CONTRACTOR ADDRESS: STREET Pa $DIC 440
<br /> CITY mlwg Iz-T 0 srATavJI1 ZIP 67)g2z,-..4
<br /> CONTRACTOR PHONE:426-214-6144 CONTRACTOR EMAIL: kill-ie.]. folval Egg?kiwir, Cpin
<br /> •
<br /> CONTRACTOR LIC.#(REQUIRED): aovig • i'/o Z CITY OF EVERETT LIUSINESS LIC.#(REQUIRED):04L95
<br /> PREMARY CONTACT: D OWNER El CONTRACTOR 0 OTHER(Please Specify)
<br /> CONTACT NAME: CONTACT PHONE: 2,06•-73,6-6544, y�`
<br /> DENI4I S d.t�•.Dl/V CONTACT EMAIL: DENA/!S. �® t��1�0IC Vv I T. 6cM
<br /> AGREEMENT:T hereby certify that I have read and examined this application and!Growth°same to be true and correct All 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 authorityto violate or cancel the provisions of any other state or
<br /> local few regulating construction or the performance of construction. That I am authorized by the owner of this property to perform the work for which appficatfonn is made and I
<br /> comply with the State Contractors Law 18.27RCW and 296.206 WAG
<br /> City of Everett Official Use Only
<br /> FEE 3 Its°
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<br /> PERMIT#
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<br /> Owner/A r orized Agent Signature Date (Revised 10/12/2015)
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