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<br /> ELECTi- ICAL PERMIT APPLICATIO •
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<br /> ►'`W- CITY OF EVERETT PERMIT SERVICES
<br /> 3200 CEDAR STREET, EVERETT,WA 98201
<br /> (P)425.257-8810 ( FAX 425-257-8857 I (E)everetteps@everettwa.gov www,everettwa.gov/permits
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<br /> PROJECT ADDRESS: i �
<br /> BUILDING AREA(if residential,new construction,remodeladdition)
<br /> SF
<br /> BUILDING TYPE: El SFR-DETACHED ❑SFR ATTACHED 0 DUPLEX a MULTI-FAMILY-#OF UNITS: 1 COMMERCIAL
<br /> USE OF BUILDING: �Q��A4G EV ET-'
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<br /> CONTRACT PRICE OF WORK:$ /3&, 00'2 •
<br /> NUMBER OF DEVICES(if low voltage):
<br /> FIRE ALARM? ❑YES /14 NO
<br /> ASSOCIATED BUILDING PERMIT#(If applicable):
<br /> DESCRIPTION OF WORK:
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<br /> OWNER NAME: TENANT NAME(If Commercial): 7A)41
<br /> OWNER MAILING ADDRESS: smear Po &Qx 3707 •
<br /> �nY 5Er Tia" STATE 11/4- 512q 2267
<br /> OWNER PHONE: ^ J /�' 7 OWNER EMAIL:
<br /> CONTRACTOR NAME:
<br /> CONTRACTOR ADDRESS; smear Po eox 4f0f
<br /> GUY mkt ie.- L.3 srAT 414- zmeig2Q4
<br /> CONTRACTOR PHONE:426-2144y 44 !CONTRACTOR EMAIL: kiig.1. 1hmErE® Com
<br /> CONTRACTOR UC.0(REQUIRED): 6ElU o z ICITY OF EVERETT i USiNESS LIC.#RI;VIRED):
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<br /> PRIMARY CONTACT: ❑OWNER @I CONTRACTOR EI OTHER(Please Specify)
<br /> CONTACT NAME: CONTACT PHONE: 264,-73 f 4510
<br /> . peM 14 15 -t•bW CONTACT EMAIL: DE NA/l S.L'R•OW® kirld r. 60n11
<br /> AGREEMENT.'T hereby certify that have read and examined this application end know the same to be true and correct All provisions oflaw,s and ordinances governing this
<br /> type of work will he completed whetherspeoThed 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 1 am authorized by the owner of this property to perform the work for which application is made and 1
<br /> comply with the State Contractors Law 18,27RGWand 298.200 WAG.
<br /> City of Everett Official Use Only
<br /> FEE
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<br /> PERMIT#QQ' f
<br /> ` vor ` �0
<br /> Owns Au or zed Agen Signature Date (Revised 10/12!2016)
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