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ORI jl�'�j�`- ELECTRICAL PERMIT APPLICATION
<br /> Albvsi -
<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 /> 1���^��� p��i��,iN( tli;, 5�,. _ m� m:iih t ,=,o-::o»^ �„ .._ ,s: x' .iawma� :�£ � 7. �§ir'x 6wia � i �r'
<br /> 1, a �I i Pr, ,�,„�( °Fj� r qy AV. 91 l�iii e 'y®J E �.. m .'i g -„z_ a0 m 'h .I,G !i,,,i m mmY I r �j._ i� -11,91-
<br /> 6,,A,,,,10,,
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<br /> _ S t ,�6� i i�. �I`i:�t ii (nhng i 71gi ���9 i - 4 fid( ti
<br /> PROJECT ADDRESS: \�\� L A vA Dr
<br /> BUILDING AREA(if residential,new construction,remodel,or addition) r I b'i-�'j l SF
<br /> BUILDING TYPE:XSFR-DETACHED 0 SFR-ATTACHED 0 DUPLEX 0 MULTI-FAMILY-#OF UNITS: 0 COMMERCIAL
<br /> USE OF BUILDING:
<br /> F id.°lY4Ptdi 4 $ t d rIIECT ALry PPLICATIoN F oriik lIONa '''7'4,':'"
<br /> xN ;
<br /> CONTRACT PRICE OF WORK: $ &03
<br /> NUMBER OF DEVICES (if low voltage):
<br /> FIRE ALARM? 0 YES 0 NO
<br /> ASSOCIATED BUILDING PERMIT# if applicable):
<br /> DESCRIPTION OF WORK: A-ci( Circ/ );—f- Pio-V /T !r7// 04 ' -
<br /> CONTACT INFOI MATIQN� E� g�
<br /> JT
<br /> 9tl��J'I �i a'i it ;i �', 4 'a s li +'�' ; °P!!dasa = i i�a9 6 iii. �.i ..� ,X81 IVIi ,'e, . .`i� a :Jal ?�n �� g Ru.
<br /> OWNER NAME: 1)a1 Ad C ue'W TENANT NAME(If Commercial):
<br /> OWNER MAILING ADDRESS: STREET
<br /> TT-18\, ..--
<br /> ?5 ,�ar ( 1.26(
<br /> CITY V y Y STATE ZIP
<br /> OWNER PHONE:L (/ - � �� OWNER EMAIL: � v��
<br /> .::.. 5 g11 l� Paz- (ueh a \ -eaves
<br /> CONTRACTOR NAME: tt kl- Fk2f,e, Q
<br /> CONTRACTOR ADDRESS: STREET1,l aJ `'��=' 3± iS/� 1 /l '�7`
<br /> CITY �� Gi T,eV !A STATE' n l- ZIP q a
<br /> CONTRACTOR PHONE:1//l/7' 1 Hr
<br /> Y4 Gill,
<br /> EMAIL:'' 1,44,c0-4,,,,D„,-,„„,17"
<br /> V`
<br /> CONTRACTOR LIC #(REQUIRED) LSV b� frifrt. CITY OF EVERETT BUSINESS LIC #(REQUIRED):Qi 776/
<br /> PRIMARY CONTACT: 0 OWNER CONTRACTOR 0 OTHER(Please Specify)
<br /> CO TACT NAME: CONTACT PHONE: ) - • I — 1/,,
<br /> A fl f \ t2PdQ4'! CONTACT EMAIL: ) a L(.<.p inri ,
<br /> AGREEMENT:T hereby certify that I ha ead and amined 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 her in 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 /> X5 .9
<br /> PERMIT#
<br /> iU7 fl 5 E 19)02 222
<br /> ner/Aethgri ed-..- nt Sig ufe" Date (Revised 10/12/2015)
<br />
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