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<br /> / ,: ELECTRICAL PERMIT APPLICATION
<br /> 'I�A�i�-r�
<br /> CITY OF EVERETT PERMIT SERVICES
<br /> ��� 3200 CEDAR STREET, EVERETT,WA 98201
<br /> (P)425-257-8810 ] FAX 425-257-8857 1 (E)everetteps@everettwa.gov] www.everettwa.gov/permits
<br /> ' • - rOJke1',:S- FOti{�'{r/��]�TIO a..- :.:F.,:—.'• •,.r ':r
<br /> PROJECT ADDRESS: -4/2S ! l 6e110/4L. 172-9
<br /> BUILDING AREA(if residential,new construction,remodel,or addition) SF '
<br /> BUILDING TYPE: El SFR-DETACHED CI SFR ATTACHED El DUPLEX LI MULTI-FAMILY-#OF UNITS: NI COMMERCIAL
<br /> USE OF BUILDING: 0E ',4G EVF-. E T •
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<br /> CONTRACT PRICE OF WORK:$ #.'/2400
<br /> NUMBER OF DEVICES(if low voltage):•
<br /> FIRE ALARM? D YES lil NO
<br /> ASSOCIATED BUILDING PERMIT#(if applicable):
<br /> DESCRIPTION OF WO ," 140‘1-44CJ7V ' lfyf i , i ';izz
<br /> mglik, d4r-itzege -
<br /> , E:-.5/40, I -. , ,
<br /> ;. _'- .. . • : - . .. •CO 'TACT`1NFOR11,lb,T10N::. - :--.....,-.::.:-...:.,7;:',....:'-;-:.'1'...;:1:1-::::
<br /> OWNER NAME: TENANT NAME(If Commercial): BCE,#)6
<br /> OWNER MAILING ADDRESS: smEEr Pa ,max 3707 .
<br /> om ..5rr-��- STATE 1,01- Eiggait 2207
<br /> OWNER PHONE: OWNER EMAIL:
<br /> ... �V . h ,.. } _r}.. } ..• • wY IY .. wa•1• rl.,/I- . . I .l .I ... I .... . .. . • .. r. a�V. r. ,. r.rC (' 1
<br /> CONTRACTOR NAME: Cjt,)e-744t. zt.J,5772UCiU�T
<br /> CONTRACTOR ADDRESS: STREET Pry $LTX 440 {{�
<br /> cm( "nag/G722 srAmlfl///
<br /> � ZIP 9R2.04
<br /> CONTRACTOR PHONE:426-214-6144
<br /> CONTRACTOR EMAIL: k4/2.). .,.j /) E14� )ki 'wiz, avn
<br /> CONTRACTOR LIC.#(REQ,UI0EN46 . 11X )Z.__ 19,122F EVERETT USIN.ESS LIC.#(REQUIRED):0405
<br /> ..
<br /> PRIMARY CONTACT: El OWNER El CONTRACTOR El OTHER(Please Specify) •
<br /> CONTACT NAME: CONTACT PHONE: 206,-73 b-a,54-
<br /> . DgiP41 s £ DWWJ CONTACT EMAIL: DEAN IS.6A014)a /:IE'wtiT. 4o
<br /> AGREEMENT:T hereby certify that 1 have read and examined this application and know the same to be true and correct Ail provisions of laws and ordinances governing this
<br /> type of work will be completed whether specilled 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 law regulating construction or the performance of construction. That!am authorized by the owner of this property to perform the work for which application is made and!
<br /> comply with the Slate Contractors Law la27 RCW and 296.20!WAC.
<br /> City of Everett Official Use Only
<br /> FEE "
<br /> ter/ 01)3. 610
<br /> PERMIT#
<br /> di / //tea-/? E f I \ og
<br /> Owner/Au o zed Agen Signature Date (Revised 10/97/2096)
<br />
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