|
Sao/
<br /> ELECTRICAL PERMIT APPLICATION
<br /> CITY OF EVERETT PERMIT SERVICES
<br /> 3200 CEDAR STREET, EVERETT,WA 98201
<br /> (P)428-257-8810 ( FAX 426-'257.8857 ( (E)everetteps@everettwagov I vwvw.everettwa.gov/permits
<br /> t:s.rr.i•�i:- .. .•t`• �. - .. a �. ^ry� -.. r
<br /> r ., . . a r .Wa,a ir' .h•e�av::k, .;.:Y•::...a.,...rr,.a. ,y.��•.- .. .':'._..._..'r.. ... ... . - a .:.,a{.:air
<br /> PROJECT ADDRESS: - ? al/
<br /> BUILDING AREA(if residential,new construction,remodel,or addition) SF •
<br /> BUILDING TYPE: Q SFR DETACHED ❑SFR-ATTACHED 0 DUPLEX 0 MULTI-FAMILY #OF UNITS: g COMMERCIAL
<br /> USE OF BUILDING: 0E1/4& EVE,eE T.
<br /> ;�;�r'v�s.:t,�<t:�•i,ii• :•:arpr•, ,.....kw ,,,-- _ �,_.. _ ..k•;y.;,,:�.,�s,r:.�e. -,� � E
<br /> ::asv,. ., .<ier:i:+..._._.•ice.:.::a-,;.�i`.r_.. ..J)'•.w vt:.Lx�/a..SS?.vi;�4.1a•r....a_.,..:r.•<,:•��•.•-.n�s•.....��+'¢7.nv .r:rw•..r..o-.Vr�..}:. _�...:iu'n)n�?:.i:�....a��a[ri,,L_.:,nr F�2 ir:•.a.v_t i.:.tt�:
<br /> CONTRACT PRICE OF WORK:$ /75-DD(9
<br /> NUMBER OF DEVICES(if low voltage):
<br /> FIRE ALARM? 0 YES g NO
<br /> ASSOCIATED BUILDING PERMIT#(if applicable):
<br /> DESCRIPTION OF WORK: �J,,' 7441/-Q
<br /> — 10 leg .4iApioz-ezd
<br /> •
<br /> v.S , ,.. . •
<br /> OWNER NAME: TENANT NAME(If Commercial): iit.)>
<br /> OWNER MAILING ADDRESS: sneer R2 80X 37o7
<br /> .501"T i.. STATE Wit uFg/241-2207
<br /> OWNER PHONE: OWNER EMAIL:
<br /> au a HV r . !. ,.. } .aw•. 5• .r.. t . . M r r• G ....a a rr,w. . . 1 .t t .. _I •• • ._ ra a w „ra.. .yk. rr ,. r—.. '�f a
<br /> CONTRACTOR NAME: 61 d0;6 r Q
<br /> CONTRACTOR ADDRESS: STREET yyPot/Box 41, /Q /�l J
<br /> cM hu // 7E22 5rATEm 1 mpgg. ,6 L
<br /> CONTRACTOR PHONE:426-294 4- 44 CONTRACTOR EMAIL: 1<A-ie.'. H4MM E ki wi r. e.orn
<br /> CONTRACTOR LIC.#(REQUIRED): agimgCc., `/Q Z CITY OF EVERETT BUSINESS LIC.#(REQUIRED):04O5ff
<br /> . „„r .��,ssn..•r•....a...,,..r,...<....u.ra>vrmo..r.r,..,...,...u.. r m..� ....,mow.,..,,..,.ry•.. ........ ...e.><.«ne—..w.,R.... >w-..�v,w.....w..4 ,-mow„-r..�w....a•,.w�..r w.r�z a...n.«-„•:m $'. we
<br /> PRIMARY CONTACT: 0 OWNER El CONTRACTOR 0 OTHER(Please Specify)
<br /> CONTACT NAME: CONTACT PHONE: 204,-736-654.1]
<br /> . 1)�` 14 15 £ OW CONTACT EMAIL: D 1 AI Ig Cgr4U1® l:i t/i r. 60.14
<br /> AGREEMENT:T hereby certify that/have read and examined this application and know the same to be true and correct All 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 law regulating construction or the performance of construction That I am authorized by the owner of this properly to perform the work fix-which application is made and 1
<br /> comply with the State Contractors Law 18.27 RCWand 298.200 WAC.
<br /> City of Everett Official Use Only
<br /> FEES a
<br /> O
<br /> C).2 .5—Z9
<br /> PERMIT#
<br /> Q _ •
<br /> ,/ E \SOL( —ILA 3
<br /> Owner/Au or zed Agent Signature Date (Revised 10/12/2015)
<br />
|