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<br /> =., ELECTRICAL PERMIT APPLICATION
<br /> varidWil CITY OF EVERETT PERMIT SERVICES
<br /> 3200 CEDAR STREET, EVERETT, WA 98201
<br /> (P)425-257-8810 I FAX 425-257-8857 1 (E) everetteps@everettwa.gov I www.everettwa.gov/permits
<br /> > 4 M F',3rf�'`Y }1 a k liy _b IE*$0#0* IN3 b :Il�TI� i K f 5 S*n' £ `1t �.��*L' �s�
<br /> .. .. ,.,..,.•e.,..x ...., �. �'..,�>�,. ?a. -�'.�:........�, r...�� .R�n..�x.,:,..<.„c w. . aA�k . `�s �. ..AU a,.�. .w��,.�: ,� ..Z_.�.�., ..,,,,�>.. ,.,z�...... «stx�;fim ..�:w�3.. �.�,.<
<br /> PROJECT ADDRESS: \
<br /> BUILDING AREA(if residential, new construction, remodel,or addition) SF
<br /> BUILDING TYPE: 0 SFR-DETACHED 0 SFR-ATTACHED 0 DUPLEX 0 MULTI-FAMILY-#OF UNITS: 0 COMMERCIAL
<br /> USE OF BUILDING: , . _
<br /> _ Ilii„IEG ilidA 1OKIC irldttitt1 oitmAtto1+�`4fin . t t x..;. . ?�.
<br /> CONTRACT PRICE OF WORK: $ 1... ..c r,,<\,�,,-\
<br /> NUMBER OF DEVICES (if low voltage):
<br /> FIRE ALARM? 0 YES 0 NO
<br /> ASSOCIATED BUILDING PERMIT#(if applicable): r 1
<br /> DESCRIPTION OF WORK: C7-1,...V0 17 400cte i 2sc w�/NT
<br /> — C•,�c,,c,,6- p
<br /> Ocv-Lua Irro.47 't INA.a c C t v-/ k/ wi SZQ 1 c 4C 1
<br /> e X-)-P7 t s3s3,&., t.,1l`) )-!Q 4 o c/c/e.c.
<br /> CONTACT IIN ORMATION
<br /> OWNER NAME: TENANT NAME(If Commercial):
<br /> OWNER MAILING ADDRESS: STREET
<br /> CITY STATE ZIP
<br /> OWNER PHONE: OWNER EMAIL:
<br /> 9-3
<br /> CONTRACTOR NAME: G t;�`� _ .....r..\se z-----,-4,...,/,:e- 2C-�-
<br /> CONTRACTOR ADDRESS: STREET C 1 -t c� 3 y(' L' /
<br /> CITY (-'( /I ( /4.043
<br /> STATE LAA ZIP r8 . 'c
<br /> CONTRACTOR PHONE: CONTRACTOR EMAIL:
<br /> CONTRACTOR LIC.#(REQUIRED): [CITY OF EVERETT BUSINESS LIC.#(REQUIRED): �--).4
<br /> PRIMARY CONTACT: ❑OWNER •NTRACTOR 0 OTHER(Please Specify)
<br /> CONTACT NAME: CONTACT PHONE: G-f - eir--j 5, g)T
<br /> A (Of 1 CONTACT EMAIL: 80301 Cdec' / C 0toe , c(\lN
<br /> AGREEMENT: �ereby 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 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 /> l/
<br /> PERMIT#
<br /> dp E I (6 t 6- n-/-
<br /> D
<br /> Owne rized •gent Signature Date (Revised 9/23/2016)
<br />
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