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• <br /> ELECTRICAL TQCF-MJT PPLICATIIN <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT,WA 98201 • <br /> (P)425-257-8810 1 FAX 425-257-8857 E (E) everetteps@a everettwa.gov I www.everettwa.govlpermits <br /> �j�=?r~t'ta•�f:. =:f• �li+• QST:' :��+4' •;•"Yty,��•,=lv �7,�j - - �1�.�y�t•1..typ�»■4.=Ahu..t���...:S= ['1" _'I:Y•[ai,�. `•J,.h:aY.'=:y...�=_... <br /> _ t�1~j� 6JnY itai�6i"Ain7A'H F3it'P{gI��7R•y����77��(���[M�4i� �`r�• •.i`. <br /> k�•:-r..,'•ala. • i'.i .l+•r�. •I.•' l.•• <br /> r_. ,i..,...a...i«. .. .. .. ....i'.:.i .... ..J,'"dct.•tNu•R•nrf.'i..n•ir...5.:n=r.'.v.rkr.•...,:.-c2_.-.^a r.•sr.:�;'`�isr'•. r.a ..... .F=...:_.,... .._..t_:.... >• .r •;..lv.r,•e.:.yr <br /> �I J' <br /> LI ADDRESS: � .»�,,...: •t ��I41{1 ��:,.�Fit i._,�\ km <br /> BUILDING AREA(if residential,new construction,remodel,or aMItidn) SF . <br /> BUILDING TYPE: ❑SFR DETACHED 0 SFR ATTACHED 0 DUPLEX >a MULTI-FAMILY-#OF UNITS: M COMMERCIAL <br /> USE OF BUILDING: :QEVkI& E1 ETT <br /> Y :at .!r4 ,. a R -oic.n ' '�� � -oRwu -Iio •i•ht ._: � '7114F) <br /> .146; .iJna-ht,.]: ..s.s tTat•al\_.•I4 <br /> CONTRACT PRICE OF WORK:$ "i c/Q(, <br /> NUMBER OF DEVICES(if low voltage): <br /> FIRE ALARM? d YES J NO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): • <br /> DESCRIPTION OF WORK: ( eril ,. 1•t 0 tit) (46 w'''� "�, • 4 ; 5 <br /> ' ,GOI 'TAC`4';IFt1RIVlgT10 :` =;4 <br /> OWNER NAME: • TENANT NAME(If Commercial): Be:g)Jt)6 <br /> OWNER MAILING ADDRESS: sTREEr Pa 3707 • <br /> env ,>5EAT-LE STATE VA 7JI/I2 —2267 <br /> OWNER PHONE: OWNER EMAIL: <br /> M1.• xU ♦ w ... _Sf._+4•• 4 r -r . • H J IY r. L•••, ir:,pi. . • , +I , •.• , .i_ . lir r ,. .i•r .+V lir •.. , S , <br /> CONTRACTOR NAME: eiJ 'L pi.)5 e 1J -ro <br /> CONTRACTOR ADDRESS: mem' Po -13OX 4� <br /> CITYm ���, � sTATEt/I,* ZIP gg204 <br /> • <br /> CONTRACTOR PHONE:425-2/424-/ q44 CONTRACTOR EMAIL: kilyei. H4vnME k'/ W/r. L'Din <br /> CONTRACTOR LIC.#(REQUIRED): 6EAls ie e 8'401 CITY OF EVERETT LOUSINESS LIG.#(REQUIRED):040511 <br /> PRIMARY CONTACT: 0 OWNER El CONTRACTOR HEl OTHER(Please Specify) <br /> CONTACT NAME: r C:rJ� <br /> CONTACT PHONE: 20(e-73Ab�-(1�'154 i$ <br /> . 1:x15 6e�b Ui CONTACT EMAIL: DEN 1 S o�E/ Y/ 15,1 iki/I/f I T. OIi1 <br /> AGREEMENT;T hereby certify that I have react and examined this application and knowthe same to be true and correct Afl provisions of lams and ordinances governing this <br /> type of work wlflbe completed whetherspecified herein or not The granting of a permit does not presume to give authority to violate or cancel the provisions of any other state or <br /> locailaw regulating construction orlhe performance of construction. That f am authorized by the owner o€this property to perform the work for which application Is made and 1 <br /> comply with the State Contractors Law 18.27 ROW and 296.20d WRC <br /> City of Everett Official Use Only <br /> FEE 45`On <br /> ' s <br /> PERMIT# <br /> di � E 1(6.05" 6611 <br /> Owner/Au l or zed Agen Signature Date (Revised 10/12/2015) <br />