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ELECTRICAL PERMIT APICATION
<br /> 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 /> �1-s'tt Y _, . Lem i'y ?-^t a rRaAj�- iy '"�I�I� r, , t tiC �f r a� '� ` �*. .max- "kix.c. v SG ;
<br /> ' .-..w`..:"\" .. 4.a te .< Ui.. v...k....-. . .\��. 11,,�1 � AY}I IAI_ II� I II� 11�. 41Ti... vix-.An i�?Co .a..� .{t�lcr=I*Ns:Z. _C
<br /> PROJECT ADDRESS: c.\ti ',,,.Q.F,\ ick,��1c...4 .1
<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: SNa51i, -q,,,,�,c,�
<br /> 1 N e _,x s n �* i ve c 1 IEIrgktll;lK-4. t li,f* tt4N N�0,OH .� I( ' e. a S,� a£SS�rh�nw' ,� *„3. z �Z�
<br /> ..._ '._...d ....:w �.. .r.,:g. �.,,rr�r.�...,'�.,.. .....,.�,<. ..s ,. ,.,.<.�.�..r, �avl..Y v.-...s.,^u..1•,ax..,. T.. ,z�'�.....e 3. ., s...,tom.�$$ Xm,s..a _..L, c. rt.,._....
<br /> CONTRACT PRICE OF WORK:$ co-0 0
<br /> NUMBER OF DEVICES (if low voltage):
<br /> FIRE ALARM? ❑YES 0 NO _
<br /> ASSOCIATED BUILDING PERMIT#(if applicable): ► Y l 9j ( 0 ' O0�
<br /> DESCRIPTION OF WORK: N,c ) 064 p,Av— cktr—` + ` kirwtcrJ k Lt.i4rt:/is
<br /> �� Av S
<br /> ;CONTA.CT INFORMATION
<br /> OWNER NAME: TENANT NAME(If Commercial):
<br /> OWNER MAILING ADDRESS: STREET
<br /> CITY STATE ZIP
<br /> OWNER PHONE: OWNER EMAIL:
<br /> CONTRACTOR NAME: Gc.Q,r, r<i- F'I,,Airtt /LL
<br /> CONTRACTOR ADDRESS: STREET rp, v r�7c 'IC
<br /> CITY r1 A 14e4.1 STATE tAA ZIP qI).-2T—
<br /> CONTRACTOR PHONE: 105=chi ,-S 7 R CONTRACTOR EMAIL:
<br /> CONTRACTOR LIC.#(REQUIRED): CITY OF EVERETT BUSINESS LIC.#(REQUIRED)0533—
<br /> 21
<br /> PRIMARY CONTACT: 0 OWNER CE�" RACTOR 0 OTHER(Please Specify)
<br /> CONTACT NAME: CONTACT PHONE: 0 - `'f - ' j O
<br /> t Sjrl4 CONTACT EMAIL: Geci�•crtSe- elfs'r/,ie-(5 L1 . Cb.-1
<br /> AGREEMENT:I hereby 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 /> �I,1
<br /> PERMIT#
<br /> d /0_-3,_)-,) 2 E 1 lo 1. 0�-o$2
<br /> O er/Autirize. A.- ignature Date (Revised 9/23/2016)
<br />
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