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08/30/2018 10:29 #0823 P. 002/002
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<br /> ePt- ELECTRICAL PERMIT APPLICATION
<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 J www.everettwa.gov/permits
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<br /> PROJECT ADDRESS: fl 7T-W Gar /fit, W.�" :._;� ... .. .. .......
<br /> BUILDING AREA(if residential,new construction,remodel,or addition) SF
<br /> BUILDING TYPE: ID SFR-DETACHED ❑SFR-ATTACHED 1::1 DUPLEX 0 MULTI-FAMILY-#OF UNITS: ID COMMERCIAL
<br /> USE OF BUILDING: sc2,
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<br /> CONTRACT PRICE OF WORK:$ ASaO
<br /> NUMBER OF DEVICES(if low voltag):
<br /> FIRE ALARM? ❑YES 0 NO
<br /> ASSOCIATED BUILDING PERMIT#(if applicable):
<br /> DESCRIPTION OF WORK: . P LA*T Q 4..Fu
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<br /> OWNER NAME: U TENANT NAME If commercial :
<br /> OWNER MAILING ADDRESS: sTREET ? ,///gam-C--€044--d
<br /> f n ULT STATE AVIL ZIP/ olaj
<br /> OWNER PHONE: OWNER EMAIL:
<br /> CONTRACTOR,NAME: EV4,441® .rt&,(
<br /> CONTRACTOR ADDRESS: STREET p // 4 1{E
<br /> CITY • IL, r / F �f ��/ STATE v1(� YIP
<br /> CONTRACTOR PHONE: WI )S" CONTRACTOR EMAIL:
<br /> CONTRACTOR LIC_It(REOUIRED: .I L f�f` CITY OF EVERETT BUSINESS LIC.#(REQUIRED):U'/4.7
<br /> 4,7
<br /> PRIMARY CONTACT: L7 OWNER 1 1 CONTRACTOR .Q OTHER(Please Specify) /tt, 4 etClA(/ 111/44441/4&
<br /> CONTACT NAME: CONTACT PHONE: tn./ 2.3 / .22 �>�
<br /> Oz,00 L O N-NA-cr 9 f CONTACT EMAIL:
<br /> AGREEMENT T hereby certify that/have read and examined his 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 property to perform the work for which application/s made and I
<br /> comply with the State Contractors Law 10.27 ROW and 296.200 WAC.
<br /> City of Everett Official Use Only
<br /> 'FEE
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<br /> Zoo
<br /> PERMIT#
<br /> ,i 7CIf EL C (QosZ --003
<br /> Ow':r/Authorized Agent Signature Date (Revised 14/12/2015)
<br /> • (1)11 ","9
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