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/0i---25 2,83/ 3271
<br /> �,�► ELECTRICAL PERMIT A}PPLJCATII
<br /> CITY OF EVERETT PERMIT SERVICES
<br /> 3200 CEDAR STREET, EVERETT', WA 98201
<br /> (P)425-257-8810 j FAX 425-257-8857 j (E)everetteps@everettwa_gov( www.everettwa.govlpermits
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<br /> PROJECT ADDRESS: -9-0-53L Z L Gy
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<br /> BUILDING AREA(If residential,new construction,remodel,(i«addition) SF .
<br /> BUILDING TYPE: 0 SFR DETACHED IJ SFR ATTACHED El DUPLEX El MULTI-FAMILY-f#OF UNITS: Q COMMERCIAL
<br /> USE OF BUILDING: sOE '!4G EVER.ET7 •
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<br /> CONTRACT PRICE OF WORK:$ 551 7
<br /> NUMBER OF DEVICES(if low voltage):' }
<br /> FIRE ALARM? ❑YES 14 NO
<br /> ASSOCIATED BUILDING PERMIT#(if applicable):
<br /> DESCRIPTION OF WORK: / L ,2.,€ ; �^• "F6.,,, l �1L
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<br /> OWNER NAME: TENANT NAME(If Commercial): . "/tl.)!
<br /> OWNER MAILING ADDRESS: STREET' f% go( 3707 •
<br /> Crry ..5 ' TLE STATE W/1- si@ /22-2207
<br /> OWNER PHONE: OWNER EMAIL:
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<br /> CONTRACTOR NAME: g �Ji 5Tnue..17L)A.) _
<br /> CONTRACTOR ADDRESS: STREET Pa//>i3OX 4/p Q J
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<br /> CONTRACTOR PHONE:42 -294 -6944 'CONTRACTOR EMAIL: jag./. kbtAlMEi 2'/ ',,j/r. LD/f
<br /> CONTRACTOR LIC Y#(REG1UiRED: L�EIII g 40Z CITY OF)~...,. T I.5USINESS L[C. (tzEQU]REo):0405
<br /> PRIMARY CONTACT: CI OWNER ET CONTRACTOR •y❑OTHER(Please Specify)
<br /> CONTACT NAME: p ,.` CONTACT PHONE: 204,-736--654 a .
<br /> pgI,I!1/441 5 e...evW CONTACT EMAIL; DEKA/lg. .,g.ow a kik-m T. L'am
<br /> AGREEMENT:T hereby codify that l 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 whetherspecified 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 /> focal few 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 Slate Contractors Law 18.27 RCW and 296.200.WAC
<br /> City of Everett Official Use Only
<br /> FEE/61 7l 7
<br /> PERMIT#
<br /> ��: / " E kZo4 -- tZl
<br /> Owner/Au ori ed Agent Sig nature Date u
<br /> z (Revised 10/12/2016)
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