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ELECTRICAL PERMIT APPLICATION
<br /> CITY OF EVERETT PERMIT SERVICES
<br /> 3200 CEDAR STREET,EVERETT,WA 98201 •
<br /> (P)425-267.8810 J FAX 425-257-8857 (E)everetteps@everettwa.gov j www.everettwa.gov/permits
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<br /> PROJECT ADDRESS: `"I V' �"I .(B1.1 1 v d i t -001u.
<br /> BUILDING AREA(if residential,new construction,remodel,or addition SF
<br /> BUILDING TYPE: E1 SFR-DETACHED El SFR-ATI-ACHED 0 DUPLEX D MULTI-FAMILY-#OF UNITS: NI COMMERCIAL
<br /> USE OF BUILDING: 'j�'J (�
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<br /> CONTRACT PRICE OF WORK:$ �� On
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<br /> NUMBER OF DEVICES(if low voltage):'
<br /> FIRE ALARM? D YES NO
<br /> ASSOCIATED BUILDING PERMIT#(if applicable): 1-0,:)111m,
<br /> DESCRIPTION OF WORK: t 1.•.f PVY) 10 uki 0---16: .
<br /> OWNER NAME: TENANT NAME(If Commercial): E,E1/t}6
<br /> OWNER MAILING ADDRESS: STREET fl.5E-AV-LEE X 5707 � �{
<br /> Cm♦ aaweWitI l22/- 2207
<br /> OWNER PHONE: OWNER EMAIL:
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<br /> CONTRACTORNAME: �/� ,�. (1,PP5T72u6ro&)
<br /> CONTRACTOR ADDRESS: STREET yyP�t�2�/'�2X -41t Q /�l�I
<br /> OW "nag I !G.[ 2 STATE��/ ZIP 9[g2L/ L
<br /> CONTRACTOR PHONE:425-294`6942-/ CONTRACTOR EMAIL: kA-ie f. i , ih,l)')Eg& Coin
<br /> CONTRACTOR 1.IC #(REQUIRED): C7�1���r� g' o z. CITY OF EVERETT BUSINESS LIC.#(REGIUIRED):°`-f u ••
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<br /> PRIMARY CONTACT: D OWNER Il CONTRACTOR D OTHER(Please Specify)
<br /> CONTACT NAME: CONTACT PHONE: 20,6_~73 6.45'-&
<br /> • j�JJl4!5 6t.-•DX11/ CONTACT EMAIL: DDENA/lS.LL lzoid)e klE'1 VI T. d iv
<br /> AGREEMENT:T hereby certify that I have read and examined this application and know the same to be true and correct. All provisions of laws and ordinances governing this
<br /> Ore of work will be compieted whether specified herein or not: The granting of a permit does not presume to give authorltyto violate or cancel the provisions of any other state or
<br /> local taw regulating construction or the performance of construction. That f am authorized by the owner of this property to perform the work for which application Ls made and I
<br /> comply with the State Contractors Law 18.27 RCW and 288.200.WAC
<br /> City of Evenatt Official Use Only
<br /> FEE• 250' ""
<br /> PERMIT#
<br /> Owner/Au o4-Agent Srignature Date (Revised 102/2015)
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