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<br /> ELECTRICAL PERMIT APPLICATUY,
<br /> '7•4i* ''/-*. —A CITY OF EVERE I 1 PERMIT SERVICES
<br /> 3200 CEDAR STREET, EVERETT, WA 98201
<br /> (P)425-257-8810 1 FAX 425-257-8857 J (E) everetteps@everettwagov J www.everettwagov/permits
<br /> :. ; • .., .:,;.:, i 1 :' .:: .: . .:.:0104.0c1r$0E10:00014600.N.
<br /> PROJECT ADDRESS: (01.i 1 C-0'itytiNk e v c L'‘......e 0 k.1C.,
<br /> BUILDING AREA(if residential,new construction,remodel,or addition) SF
<br /> BUILDING TYPE: 1N,SFR-DETACHED 0 SFR-ATTACHED El DUPLEX 0 MULTI-FAMILY-#OF UNITS: 0 COMMERCIAL
<br /> USE OF BUILDING: S f 12-
<br /> :,,. '- ,. I : .. • . :-... : ... ELECTRICAL APPLICATION iti0iitmA1ioN .. . , .
<br /> CONTRACT PRICE OF WORK:$ dc.e-tc,
<br /> NUMBER OF DEVICES(if low voltage):
<br /> FIRE ALARM? EI YES 9 NO
<br /> ASSOCIATED BUILDING PERMIT#(if applicable):
<br /> L.' i
<br /> DESCRIPTION OF WORK: f> LI,t€ L C.,t,L4,.. C it.v.4... a- .ot.C41.1A i ft IfYi44- ._ C i tt ilc
<br /> CONTACT INFORMATION .,, .. _ . • .
<br /> -OWNER NAME:' ,,j 0,ilf\e-c cta.- y . TENANT NAME(If Commercial):
<br /> OWNER MAILING ADDRESS: STREET (17 1 1 CC-VIA N Le it C-
<br /> ,
<br /> ' CrTY E\)e re fi-: ' STATE 1,-(...,4t ZIP q ej 0 3
<br /> OWNER PHONE: OWNER EMAIL:
<br /> CONTRACTOR NAME: POSt t-I etettp lc INC
<br /> CONTRACTOR ADDRESS: MEET P0 1;-L,X. ii-083
<br /> CITY LA1Le ST E V 00c STATE i...41 zip 63 8 1.
<br /> CONTRACTOR PHONE: #4 ZS- 14 7 S 7 i,,,,,s CONTRACTOR EMAIL: bl:cc itel.ectint.i.Ace trvi-16-ty 1,,... brvyt
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<br /> CONTRACTOR LIC.#(REQUIRED): t3. i.:'Set+ Ur/3 if.,1) CITY OF „EVERETT BUSINESS LIC.#(REOUIRED):t„,itlf),.!.1!,.,_
<br /> PRIMARY CONTACT: 0 OWNER III CONTRACTOR 0 OTHER(Please Specify)
<br /> CONTACT NAME: CONTACT PHONE: if Z.9 LO 9 '''
<br /> jG( bOSC,I/\.. CONTACT EMAIL: 0 5 c i„, e Le c i-v.1 c l,,,,c(.4 .
<br /> AGREEMENT:Thereby certify that/have read and examined this application and know the same to be true and comsat 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 orthe 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 298.200 WAC.
<br /> City of Everett Official Use Only
<br /> FEE '
<br /> CC ---
<br /> PERMIT#
<br /> .
<br /> 2 Cfri:',),
<br /> E 1 ' '(--51 - 01'1
<br /> I. m q/51/g
<br /> Ovvn /Authorized Agent Signature Date , (Revised 10/12/2015)
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