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<br /> ELECTRICAL PERMIT APPLICATION 52
<br /> CITY OF EVERETT PERMIT SERVICES
<br /> 3200 CEDAR STREET, EVERETT,WA 98201
<br /> (P)425•-257-8810 FAX 425257-8857 1 (E)everetteps@everettwa•gov I www.everettwargov/permits
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<br /> PROJECT ADDRESS: /aIO2z/d2 ,,,
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<br /> BUILDING AREA(if residential,new construction,remodel,or a ition) SF
<br /> BUILDING TYPE: El SFR-DETACHED El SFR-ATTACHED O DUPLEX 4 MULTI-FAMILY-#OF UNITS: j COMMERCIAL
<br /> usE OF BUILDING: e: G EVV:EE'TT'
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<br /> CONTRACT PRICE OF WORK:$ /5 O
<br /> NUMBER OF DEVICES(if low voltage):•
<br /> FIRE ALARM? D YES
<br /> )4 NO
<br /> ASSOCIATED BUILDING PERMIT#(if applicable):
<br /> DESCRIPTION OF WORK: C A'dh I( /6.44e6,1/ 2 /1,44.114141446,:.,
<br /> l'gl / 14/0A2 icbs®re/i
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<br /> �.�. vsj. 17`ACT:IN Oit14 ,i OM::.. .
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<br /> OWNER NAME: TENANT NAME(if Commercial): pC: /lt•)�
<br /> OWNER MAILING ADDRESS: STREET Iib exv 3707 •
<br /> cry STATE v✓/4- zi 7 /24 22x7
<br /> OWNER PHONE: OWNER EMAIL:
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<br /> CONTRACTOR NAME: 4iV tZ. e,P5n L1c,7'/c)/(.J
<br /> CONTRACTOR ADDRESS: STREET Pa $DJC 4/,
<br /> CU'! STATEV)
<br /> CONTRACTOR PHONE:426-294-6944 CONTRACTOR EMAIL: k4 QC`. thvilmEgic E 'T. dDin
<br /> CONTRACTOR LIC.#(REQUIRED): 44n1 .t 1 4D Z CITY OF EVERETT BUSINESS LIC.#(REQUIRED): 0,59
<br /> PRIMARY CONTACT: ❑OWNER CONTRACTOR 0 OTHER(Please Specify)
<br /> CONTACT NAME: CONTACT PHONE: 206-736-6544p •
<br /> 15 6eo(,tl CONTACT EMAIL: DENN IS 6.014l o I'IEw`iT. 60/4
<br /> AGREEMENT:T hereby certify that 1 have read and examined this application and know the same to be true and correct All provisions of laws and ordinances governing this
<br /> Om of work will be completed whether speckled herein or not. The granting of a permit does not presume to give authorifyfoo violate or cancel the provisions of any otherstate of
<br /> local law regulating construction or the performance of construction. That l 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 RCW and 298.20d WAC.
<br /> City of Everett Official Use Only
<br /> FEE � 2
<br /> 315
<br /> •
<br /> PERMIT#
<br /> Owner Au or ed Agen Signature Date (Revised 10/12/2016)
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