|
ELECTRICAL PE MITT APPLICATION
<br /> CITY OF EVERETT PERMIT SERVICES
<br /> 3200 CEDAR STREET, EVERETT,WA 98201
<br /> (P)425-257-8810 J FAX 425-257.8857 I (E)everetteps@everettwa.gov I www.everettwa.govlpermits
<br /> •ti,• .. .,r . ... . .s.Jy-3.�.h' nr••u..t:n.•.:@,�. ,..Tai'���r'.•#I:,L'+urrdr.i•..:..`v: _ ,. .-.:...w.._. �.. � �? r .. ..�r
<br /> PROJECT ADDRESS: ' Lif.0-L29 .t i no, .,0,1 y) -�'-
<br /> BUILDING AREA(if residential,new construction,remodel,or addltijn) SF '
<br /> BUILDING TYPE: El SFR-DETACHED El SFR-ATTACHED 0 DUPLEX 0 MULTI-FAMILY-#OF UNITS: g COMMERCIAL
<br /> USE OF BUiLDING; goEr4G1/�, T-I
<br /> �i,.�w q�w :•,al p^ii:'iat.tu.� .. ..{.,pnpn _ - .a,..0.r.r- _ e,•.��. ..�,,:..tile?r':'n'7,'>':e.'..4 •reai'a+V..aid::: *n,
<br /> PS•..{, `:' ,rp .,•5.' .rl'.i � t',.v `^�'.' j `(,,.r:-M1,ir
<br /> :es'er.:i.''s•..+ws:..•..t�1.r.•s'•a�•e.o-.....7•.•_.. •:+vg,i_j:371M.. .4 rW.n•,.ar uvFxe-.+a•....,.v,..i�'_a... :wta:✓::.,r4_.:fo:gdrB P-i•.•a�fn°�3...,�.rs�1.SLkef�
<br /> CONTRACT PRICE OF WORK:$ 71 C)
<br /> NUMBER OF DEVICES(if low voltage):
<br /> FIRE ALARM? ❑YES NI NO
<br /> ASSOCIATED BUILDING PERMIT#(if applicable):
<br /> DESCRIPTION OF WORK: � P rn t t (j i -10c) ,
<br /> •
<br /> •
<br /> •
<br /> :< ,GOITi4C IINIFOR ATO •. . . .,:...
<br /> OWNER NAME: TENANT NAME(If Commercial): /A.)6
<br /> OWNER MAILING ADDRESS: STREET PO
<br /> &2)( 37o7 d /��(
<br /> CITY ✓01171 - STATE 141,4 T1 Fes/ J/2l/-2207
<br /> OWNER PHONE: OWNER EMAIL:
<br /> ,u • Mw ,. n ... n -r .. u ,_ , � , a ,l, r. ,...r. T.,.6T• <. , r r •.r ,.. r_ ... , ., , „ ,,., ,rv ., .. ,,. x
<br /> CONTRACTOR NAME: (' k)Ee . �t 1 e L1C.7'/t)t)
<br /> CONTRACTOR ADDRESS: STREET Pa &2'( X41./ a
<br /> CRY mL 4/t.m22 STATEW/ ZIP9g2e,4
<br /> CONTRACTOR PHONE:4_25-29 4-4144 CONTRACTOR EMAIL: ki-i i HitinmEAN / 'yr/l r, &i l
<br /> CONTRACTOR LIC,#(REQUIRED): (Ei 8ge.el g4Q Z .., CITY OF EVERETT BUSINESS LIC.5REQUIRED):040 9
<br /> ,rr»r-�••••,r-a.e.�.....n,••., .a r�w.,u++•n.ra«•<unw.,.,w.v _ r-+r•n,v.•, •,..�,.w,f .....a.r r.ry,+ �,++.w.w.n wn.-v.:r•� ,•�
<br /> PRIMARY CONTACT: Ci OWNER El CONTRACTOR E7 OTHER(Please Specify)
<br /> CONTACT NAME: t CONTACT PHONE: 214,-736�-tp5440
<br /> Dem1/405 15 tp O utJ CONTACT EMAIL: DENN I�j}e.,g0w o oh-101T. 6OM
<br /> AGREEMENT:T hereby certify that/have read and examined this application and knowthe same to be true and cowed All provisions of laws and ordinances governing this
<br /> type of work will be completed whether specified herein ornot The granting ofa permit does not presume to give authority to violate or cancel the provisions of any other state or
<br /> localIawregu/ating 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 1
<br /> comply with the State Contractors Law 18.27 RCWend 298.200 WAC
<br /> City of Everett Official Use Only
<br /> FEE \22 C
<br /> •
<br /> •
<br /> PERMIT#
<br /> :i,. .-/ / E / O5 - o930
<br /> OwnerA orizedA.en Signature Date (Revised 10/12/2016)
<br />
|