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ELECTRICAL PERMIT APPLICATIO • <br /> N <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT,WA 98201 <br /> (P)425-257-8810 1 FAX 425-257-8857 J (E)everetteps@everettwa.gov J www.everettwa.govlpermits <br /> s-. .,.:•jS:- ,..i�:.a...... .. .. ...Lia-;4(--1.... .... . . Y,... . a a''Jr..a.f_.f.(^:r.; ..ar. ,.u,:••'.:.:G�.:rc .ar.'•a,.. ... /' <br /> PROJECT ADDRESS: .t k! C 6\ Lt VY` Y "" 41; <br /> BUILDING AREA(if residential,new construction,remodel,or addition) SF <br /> BUILDING TYPE: 0 SFR-DETACHED 0 SFR-ATTACHED 0 DUPLEX 4 MULTI-FAMILY-#OF UNITS: J COMMERCIAL <br /> USE OF BUILDING: Z per, G EV.1FTT <br /> �•C�!;:C;,ri �;' .�,a tml....•:.•t <br /> ...,.-. a .,.. - .. i,a.•r.. .TVGT:4 :41L.ap%aNYIO �aO •p••:�rrs. �'i <br /> :y: Trq •.3,.:,t_ <br /> CONTRACT PRICE OF WORK:$ E•Dcl 1 DO <br /> NUMBER OF DEVICES(if low voltage):• <br /> FIRE ALARM? ❑YES /J NO <br /> ASSOCIATED BUILDING PERMIT# if applicable): <br /> DESCRIPTION OF WORK: 9PMEMW WOO Ibt-.5 t:i V <br /> 3 <br /> • <br /> 7.X eiaby <br /> .,,�• r r ,:ipC A�ACT'MNPt3Rf111A,TlO�+i:.. { . •.}. ..._' <br /> OWNER NAME: TENANT NAME(If Commercial): B.Ef136 <br /> OWNER MAILING ADDRESS: STREET Po ,pox 3707 <br /> oily ,501-7TLE STATE‘6/11 =lc:Mail-2207 <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: - i) jP}' •. / snev T/1,0 <br /> CONTRACTOR ADDRESS: STREET Pa e ox 41 ,�� // h <br /> Q Y 11)14 /L Tet, sTATEVII- ze l g2e)4 <br /> • <br /> CONTRACTOR PHONE:426-294-6144 CONTRACTOR EMAIL: kfi-A1. 1H4/nMEP4 kI 1�Ui7", CO/)1 <br /> CONTRACTOR LIC.,1!(REQUIRED): 6EA.16°. - ' i 40Z CITY OF EVERETT BUSINESS LIC,11 REQUIRED):MO A <br /> PRIMARY CONTACT: 0 OWNER Ili CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: 204,-73Z:7-6541a <br /> a DeN P4 1 S CJP d U1 CONTACT EMAIL: DEN Al I S,C,e'0L)t R 1 -J/l11 r. <br /> AGREEMENT:T hereby certify that!have read and examined this application and know the same to be true and correct Al!provisions of taws 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 authorltyto violate or cancel the provisions of any other state or <br /> local law regulathlg 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 I <br /> comply with the State Contractors Law 18.27 ROW and 296.20d WAC. <br /> City of Everett Official Use Only <br /> FEE <br /> D000t50 <br /> PERMIT# <br /> Et9p9— 1-11A <br /> Owner/Aa or zed Agent Signature Date (Revised 10/12/2015) <br />