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<br /> ELECTRICAL PERMIT APPLICATION
<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 www.everettwa.gov/permits
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<br /> PROJECT ADDRESS: O.. ,'""! .l Icor\A, cot c v .'
<br /> BUILDING AREA(if residential,new construction,remodel,or addition) SF
<br /> BUILDING TYPE: 0 SFR-DETACHED 0 SFR ATTACHED ❑DUPLEX MULTI-FAMILY-#OF UNITS: NI COMMERCIAL
<br /> USE OF BUILDING: jd��fl y(, �t/E ETT
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<br /> CONTRACT PRICE OF WORK:$ t ! �C •
<br /> NUMBER OF DEVICES(if low voltage):•
<br /> FIRE ALARM? 0 YES $J NO
<br /> ASSOCIATED BUILDING PERMIT#(if applicable): y�-
<br /> DESCRIPTION OF WORK: ::?,3 ?? , 1 '13 Woo F•' 1 t l
<br /> 777g. P/061--- i) 1720/.--
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<br /> 72Z-• . • GOM`TACT I[NOIR1411ATION;.•,,, •. .. •
<br /> OWNER NAME: TENANT NAME(if Commercial): BCE/A.)4,
<br /> OWNER MAILING ADDRESS: STREET f%, &,.�O)( 3707
<br /> CIN 5GTi7 l LE STATE WA- ar J�/�/�g �7
<br /> / q 2207
<br /> OWNER PHONE: OWNER EMAIL:
<br /> CONTRACTOR NAME: tl�leftZ. P57 ieue 1/dAJ
<br /> CONTRACTOR ADDRESS: STREET Po $ox��4100 n y,Q p�j�/�
<br /> CITY mU/L7GV STAT&VV1 1 ZIP gg2O l
<br /> CONTRACTOR PHONE:426-214-6944 CONTRACTOR EMAIL: kfiR1. H, /ilio E12eP kii'wE r &?'n
<br /> CONTRACTOR LIC.#(REQUIRED) agAieF4. 7vnv....o z CITY OF EVERETT BUSINESS LIC.#(REQUIl3ED):O4U5
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<br /> PRIMARY CONTACT: ❑OWNER El CONTRACTOR ❑OTHER(Please Specify) '
<br /> CONTACT NAME: p CONTACT PHONE: 2' 06-'73�11�-�t''p,f521-41 �t
<br /> . Dg f J N 1 S neo w CONTACT EMAIL: C)pj /�f^j,C._.1e17W® Iti IEW l T. &1
<br /> AGREEMENT:Thereby certify that I have read end examined this application and know the same to be true and correct Alt 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 authority to violate or cancel the provisions of any other state or
<br /> local lew regulating construction or the performance of construction. That i am authorized by the owner of this property to perform the work for which application Is made and 1
<br /> comply with the Slate Contractors Law 1827 RCW and 286.200 WAC.
<br /> City of Everett Official Use Only
<br /> FEE 7���,,! i��
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<br /> PERMIT#
<br /> / E 1%() -I (e(P
<br /> Owner/Au or zed Agen Signature Date (Revised 10/12/2016)
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