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<br /> 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 r@everettwagov I www,everettwa.gaviperrriits
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<br /> PROJECT ADDRESS: \ 0. +r r”`i t_:. .. .+- 0 f,
<br /> BUILDING AREA(if residential,new construction,remodel,or addition) SF
<br /> BUILDING TYPE: ❑:SFR-DETACHED' SFR-ATTACHED C]DUPLEX 0 MULTI-FAMILY-#OF UNITS: ID COMMERCIAL
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<br /> USE BUILDING: /
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<br /> CONTRACT PRICE OF WORK:$ '\ ,°1
<br /> NUMBER OF DEVICES(if low voltage):.
<br /> FIRE ALARM? OYES 0 NO'
<br /> ASSOCIATED BUILDING PERMIT#(if applicable):
<br /> DESCRIPTION OF WORK: c- .e `-\'v^c~s- `A"-- t cLAint .."1 1 €�.ry,,v'rt i.:4. CO._v sr\oLc..41
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<br /> OWNER NAME: S Q A-A y 1,p e S TENANT NAME(If Commercial):
<br /> OWNER MAILING ADDRESS: STREET 3"`( t L k .' c ...;t..,.,.,1 A 4,. e.
<br /> cnY 'L e.,t"e` -k; STATE '0 ZP C C7+4;-- (
<br /> OWNER PHONE 'D'-,45-6(4.--1- 0 -i. . OWNER EMAIL
<br /> CONTRACTOR NAME: ""\,p„--.r ,,;&-irt-6",rs",. tIA 0.0Z4-ti vr1 s. LK. NA c; -
<br /> CONTRACTOR ADDRESS: STREET , ,-so we`vY) S' ", .
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<br /> Cil: +\Va- Gp ,. -'E� STATE ,P4' ZIPS%r yIV
<br /> CONTRACTOR PHONE: .. - `'z)-i...fi34..1. CONTRACTOR EMAIL:p`-s;--kc e-.(' no 'clsk+r e<NA,r'c (GYyt
<br /> CONTRACTOR LIC kREQUIRED):nv , CITY OF,EVE "BUSINESS LIC #(RQUIRED) ( L_
<br /> PRIMARY CONTACT: ©OWNER ISPONTRACTOR 0 OTHER(Please Specify :.
<br /> CONTACT NAME: CONTACT PHONE: i. '
<br /> ko i, e- +4C" {' k CONTACT EMAIL:•Q41 a • r Y A -F
<br /> AGREEMENT:I hereby certify that I have read and examund this application and know the same to be true and'correct Aft provisions oftaws and ordinances gemming this typo
<br /> of work will be completed whether Specified herein or not The granting of a pemirt.dpes not,presume to give Authority to violate or cancel the provisions of Any other state or
<br /> local km regulating construction or the performance of construcstiort,That 1 am auttranzettby Me owner of this property to perform:the work kr application is made and!
<br /> comply with the State Contractors Law 1817 RCW and 296.200'WAC
<br /> City of Everett:Offioiat Use Only
<br /> PERMIT#
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<br /> mac( i E A0 -tc•-tom � g O
<br /> Owner/Authorized Agent S' nature Date (Revised 9/23/2016)
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