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<br /> LCTRICAL PERMIT APPLICATION t,
<br /> CITY OF EVERETT PERMIT SERVICES .1),OGINA
<br /> 3200 CEDAR STREET, EVERETT,WA 98201
<br /> (P) 4p2�5-257-8810 FAX 425-257-88575- I (E) everetteps@everettwa.gov I www.everettwa.gov/permits
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<br /> PR� i`'1 �1 ,,.� IV I1'r , p ),s �"r , *_ ' y = G
<br /> PROJECT ADDRESS: gr�L,P c , r(1 2 o
<br /> BUILDING AREA(if residential,new construction,remodel,or addition) el SF
<br /> BUILDING TYPE: 0 SFR-DETACHED /FR-ATTACHED 0 DUPLEX 0 MULTI-FAMILY-#OF UNITS: 0 COMMERCIAL
<br /> USE OF BUILDING: /
<br /> , 1IT Ili , ( } `d I ?kELECTRAL PPLICv TI 'NINFOR A�I� ,,,,,,,,;,,0„,:„� ! v t, �� , i l 4
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<br /> CONTRACT
<br /> PRICE OF WORK:$ u 6 V
<br /> NUMBER OF DEVICES (if low voltage):
<br /> FIRE ALARM? 0 YES 0 NO
<br /> ASSOCIATED BUILDING PERMIT#(if applicable):
<br /> DESCRIPTION OF WORK: C( V-011 ' h SI ttx 7.. /���
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<br /> '.I" 0 =-4V,i " { " }CONTACTa INFORMATION 5 „ 1 ' .; - " , 4
<br /> OWNER NAME: AV ifs TENANT NAME(If Commercial):
<br /> OWNER MAILING ADDRESS: STREET ,nt9 C ESI �i�I ^
<br /> cm,' /��V/4 STATE 1A-174\--
<br /> `-'f �//�/ZIP / ims
<br /> OWNER PHONE: 3L 0-1(a-_ (Q 111`,q 2- OWNER EMAIL: V\ 1 III
<br /> CONTRACTOR NAME: � P V 0(A K Q1
<br /> CONTRACTOR ADDRESS: STREET t l/L, 2
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<br /> CITY NA I STATE�� ZIP q 8O
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<br /> CONTRACTOR PHONE S` � J•1 (3') CONTRACTOR EMAIL: VEL r[e 1
<br /> CONTRACTOR LIC.#(REQUIRED)%1-4,4 3 cikA CITY OF EVERETT BUSINESS LIC.#(REQUIRED):(c291 J
<br /> PRIMARY CONTACT: 0 OWNER ,ONTRACTOR 0 OTHER(Please Specify)
<br /> CON pT NAME: CONTACT PHONE i., 77 1, ".7 3 /
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<br /> l ft-IAA A (lv' ' 17- CONTACT EMAIL: IA./_ C 1 _
<br /> AGREEMENT:T hereby certify that I 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 lam 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 /> FEE
<br /> qs ,......—
<br /> PERMIT#
<br /> OP 1 / 0571 1r E t'EDS — c7k9-
<br /> Owner/Autho r �u :, Date (Revised 10/12/2015)
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