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ELECTRICAL PEI* MIT APPLICATION
<br /> - CITY OF EVERETT PERMIT SERVICES
<br /> 3200 CEDAR STREET, EVERETT,WA 98201
<br /> (P)428-257-8810 I FAX 4.25-257-8857 1 (E)everetteps@everettwa.gov] www.everettwa.gov/permits
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<br /> PROJECT ADDRESS: .474,-,(27 �X .�/4740,,•.•
<br /> BUILDING AREA(if residential,new construction,remodel,or add!ion) SF
<br /> • BUILDING TYPE: El SFR-DETACHED ID SFR ATTACHED 0 DUPLEX 11 MULTI-FAMILY-#OF UNITS: NI COMMERCIAL
<br /> USE OF BUiLDING: gQ 4& EV EE f i
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<br /> CONTRACT PRICE OF WORK:$ /5,
<br /> NUMBER OF DEVICES(if low voltage): •
<br /> FIRE ALARM? ❑YES 14 NO
<br /> ASSOCIATED BUILDING PERMIT#(if applicable): , ��
<br /> DESCRIPTION OF WORK: ��� 4b. :; ,.i1,1.,4r1 „et f. ' d,
<br /> 3 /all 4 274I1a r,, G • .
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<br /> _ . -t. �coin , c7r°rlt�iFORiiiirito ...
<br /> OWNER NAME TENANT NAME(If Commercial): BCL/406
<br /> OWNER MAILING ADDRESS: maser to &')( 3707 •
<br /> airy .501.7TLE • STATE 144 218512g-2207
<br /> OWNER PHONE: OWNER EMAIL:
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<br /> CONTRACTOR NAME: geit,)geffit, 6,,U,5idd,r/CMJ
<br /> CONTRACTOR ADDRESS: sTaerr Pa $DX 440
<br /> cny /nag/LIED STATEvi+ 4pgg2az-/
<br /> CONTRACTOR PHONE:4262'J9 4/44 CONTRACTOR EMAIL: Mie 1. Htt/l7/1'1 EA 61 w!r''',1CD/Y)
<br /> CONTRACTOR LIC.#(REQUIRED): t Al fl � S D Z CITY OF EVERETT BUSINESS LIC.#(REQUIRED):
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<br /> PRIMARY CONTACT: ❑OWNER El CONTRACTOR ❑OTHER(Please Specify)
<br /> CONTACT NAME: ,� CONTACT PHONE: 204,-7619-454.4'
<br /> `1'I4
<br /> p t5 c1�-p pUFi CONTACT EMAIL: DEN 1i t5.CA0k/ff/ k1EW /JT. e0/
<br /> AGREEMENT`?•hereby certify that I have read and examined this application and know the same to be true and correct AU provisions of laws and ordinances governing this
<br /> One of work willbe completed whether specified herein or The granting of a permit does not presume to give authority to violate or cancel the provisions of any other state or
<br /> local taw regulating construction or the performance of construction. That t am authorized by the owner of this property to perform the work for which application Is made and!
<br /> comply with the State Contractors Law 18.27 RCW and 296.200 WAG.
<br /> City of Everett Official Use Only
<br /> FEE t,
<br /> PERMIT#
<br /> •
<br /> 4 15 Eft -O g.
<br /> OwnerlAu' or zed Agent Signature Date (Revised 10/1212016)
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