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08/22/2018 01 : 19 #0548 P. 001/001
<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 (E)everetteps@everettwa_gov I www.everettwa.gov/permits
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<br /> PROJECT ADDRESS: y9/6 1ZIlc_J :k AO,
<br /> BUILDING AREA(if residential, new construction,remodel,or addition) . SF
<br /> UUILDING TYPE: 0 SFR-DETACHED 0 SFR ATTACHED 0 DUPLEX ❑MULTI-FAMILY-#OF UNITS: ..Q-COMMERCIAL
<br /> USE OF BUILDING: girt r-A(tok
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<br /> CONTRACT PRICE OF WORK:$ Sap
<br /> NUMBER OF DEVICES (if low voltage): _
<br /> FIRE ALARM? 0 YES 0 NO
<br /> ASSOCIATED BUILDING PERMIT#(if applicable):
<br /> DESCRIPTION OF WORK: pevA C I/ZY v i7,S _ _
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<br /> OWNER NAME: i" IAO I) -/N:,, TENANT NAME(If Commercial):
<br /> OWNED MAILWG ADDRESS: STREET 7 ya_g t)t I
<br /> fiCITY Z O STATE /it/�- zip WI �a
<br /> OWNER PHONE: 7 j,1 ,L$2... " L -- - OWNER EMAIL:
<br /> CONTRACTOR NAME: C'L-AA,D,
<br /> CONTRACTOR ADDRESS: sTReET .f)C �,/Oa /Y ^
<br /> +�ll AA CITY €1/121' STATE //g' zIp.G1
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<br /> CONTRACTOR PHONE: II? .Z/4 f CONTRACTOR EMAIL:
<br /> CONTRACTOR LIC.#(REQUIRED):/36-44/43"/ CITY OF EVERETT BUSINESS LIC.#(REQUIRED): D/4-',
<br /> PRIMARY CONTACT: Q OWNER Q CONTRACTOR A OTHER(Please Specify)
<br /> CONTACT NAME: CONTACT PHONE: 7AS 13/
<br /> 22
<br /> eZ` / CONTACT EMAIL: r
<br /> AGREEMENT:T 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
<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 or the performance of construction. That/am author1 ed by the owner of this property to perform the work for which application is made and
<br /> comply with the State Contractors Law 18.27 RCW and 296.200 WAC
<br /> City of Everett Official Use Only
<br /> FEE
<br /> PERMIT#
<br /> // ØØg
<br /> E Vo(Co— l (vtl
<br /> Owner/Au ,'<d gent Signature
<br /> (Revised 10/12/2015)
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