|
ELECTRICAL PERMIT APPLICATION
<br /> !'�'►� CITY OF EVERETT PERMIT SERVICES
<br /> 3200 CEDAR STREET, EVERETT,WA 98201
<br /> (P)425-257-8810 I FAX 425-257-8857 I (E)everetteps@everettwa.gov I www.everettwa.gov/permits
<br /> PROJECT ADDRESS: 24D I $4 l v1 t t- '�V re4fr , VV A oezo(
<br /> BUILDING AREA(if residential,new construction,remodel,or addition) SF
<br /> BUILDING TYPE: 0 SFR-DETACHED . FR-ATTACHED 0 DUPLEX 0 MULTI-FAMILY-#OF UNITS: 0 COMMERCIAL
<br /> USE OF BUILDING: ?i" ti( VI
<br /> i,;.>o , ., '•: ,, �. ,:•r „r,,,. ,,,, :v, , ,d.. :�;'nom ,k.a:.:i ,..,.,;a,,>, ,,v�,.�,s;.:. ��' ..'�...Et���`. ,,,r'','';%.,
<br /> CONTRACT PRICE OF WORK: $ 122.S ` � r
<br /> NUMBER OF DEVICES(if low voltage):
<br /> FIRE ALARM? ❑YES 0 N
<br /> ASSOCIATED BUILDING PERMIT#(if applicable):
<br /> DESCRIPTION OF WORK: 2]0 Pimp 1 njer -f-, tb `I q h-f-s•
<br /> OWNER NAME: WIIIIA V/>/I I IV1 r1c TENANT NAME(If Commercial):
<br /> OWNER MAILING ADDRESS: STREET 21401 v r o+fri vt 9
<br /> /�
<br /> CITY /�/�ve 0 STATE VIA ZIP IQ)2.b1OWNER PHONE:420. gill I0�0 LOWNER EMAIL �. ,,..
<br /> ,.n �,. ...�
<br /> CONTRACTOR NAME: 10 11)I/I S(, -5-1.6006,11 ,c'OVV(C G s l I VI(/•
<br /> CONTRACTOR ADDRESS: STREET
<br /> r IG�fp (I i I/ DQ
<br /> CITY Ll/ t8 V I [NA- STATE INA. ZIP g02
<br /> 49i3
<br /> CONTRACTOR PHONE: /42- • . CI • 1--O
<br /> OCONTRACTOR EMAIL: I LI:et IS 01111,111. r /r
<br /> CONTRACTOR LIC.#(REQUIRED) I V 14OVC S 1329 CITY OF EVERETT BUSINESS LIC.#(REQUIRED) 014-'`1J(1(
<br /> PRIMARY CONTACT: 0 OWNER grCONTRACTOR 0 OTHER(Please Specify)
<br /> CONTACT NAME: CONTACT PHONE: /42 D 'ZcY),
<br /> { elSe tj CONTACT EMAIL: I vi2rxvvn tS(. 1•141.911 .CA'/�
<br /> AGREEMENT:I hereby certify that I have read and examined this application and know the same to be true and correct. All provisiof laws and ordinances governing this type
<br /> 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 is made and I
<br /> comply with the State Contractors Law 18.27 RCW and 296.200 WAC.
<br /> City of Everett Official Use Only
<br /> / PERMIT#
<br /> ,A i/ t atur w J 972//f,_ E l ' -
<br /> Owner/7 thori,7.Agent - Date (Revised 9/23/2016)
<br />
|