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ELECTRICAL PERMIT APP ATION
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<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@everettvia.gov I Immiv.everettvtra.goviperrnits
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<br /> PROJECT ADDRESS: :9-0/ I, ct/(:) le-c 004 pe---
<br /> BUILDING AREA(if residential, new construction, remodel,or addition) SF
<br /> BUILDING TYPE:(11FR-DETACHED 0 SFR-ATTACHED 0 DUPLEX 0 MULTI-FAMILY-#OF UNITS: 0 COMMERCIAL
<br /> USE OF BUILDING: Rec 5 ce..,2.4(.0,___
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<br /> CONTRACT PRICE OF WORK:$ 5a3
<br /> NUMBER OF DEVICES(if low voltage):
<br /> FIRE ALARM? 0 YES NO
<br /> ASSOCIATED BUILDING PERMIT#(if applicable):
<br /> DESCRIPTION OF WORK: 4-'1'4- 4'f g-6,44 l'r-
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<br /> OWNER NAME: •C.,e,... (Ai g1/4,-r(L.:yid TENANT NAME(If Commercial):
<br /> OWNER MAILING ADDRESS: STREET Of c( ri_ore(04 _t>fe_._
<br /> CITY Elet....ke." STATE 0"j 4- ZIP 41 -o3:::
<br /> OWNER PHONE: Lf Cfr'5 .--s3cs OVVNER EMAIL:
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<br /> CONTRACTOR NAME: 1-'1 410V-at— ‘•---ck-e-nt_Ae.---
<br /> CONTRACTOR ADDRESS: STREET --7(X) ( FC)f‘-' 14,tt (1C
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<br /> CITY le popt V STATE LAM— ZIP gP0'....5.'
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<br /> CONTRACTOR PHONE: '1.1-1 ,.> ' .41-i 46" l CONTRACTOR EMAIL: (AA.ttcv-E>t rw cr.vvck IzeA, t c... ,Gcs cA---
<br /> CONTRACTOR LIC.#(REQUIRED); ti i AlOC-C-INf2,4.(A.At CITY OF EVERETT BUSINESS LIC.#(REQUIRED): (i 07 041
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<br /> PRIMARY CONTACT: DOWNER p....CONTRACTOR 0 OTHER(Please Specify)
<br /> CONTACT NAME: CONTACT PHONE: (tA_s--,,.. 7(,f -27y9
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<br /> Vuk1a-7- Et,,v00,(....---- CONTACT EMAIL:
<br /> AGREEMENT:I hereby certify that!have read and examined this application and know the same to be true and correct. All provisions of 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 /> 6 tk( %()Cc, 1Li PERMIT# —
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<br /> Owner/Authorize nt
<br /> Signature Date (Revised 9/23/2016)
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