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�► 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 1 (E)everetteps@everettwa.gov 1 www.everettwa.gov/permits
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<br /> PROJECT ADDRESS: (O2 Wear)
<br /> R.JO& . Vlop'j 1,41$ 182,0"S.
<br /> BUILDING AREA(if residential,new construction,remodel,or addition) SF
<br /> BUILDING TYPE: ❑SFR-DETACHED 0 SFR-ATTACHED 0 DUPLEX 0 MULTI-FAMILY-#OF UNITS: . 0 COMMERCIAL
<br /> USE OF BUILDING: RSS I U' !Ci MLS.
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<br /> +,:;'P{•�I%I i>.ill�''''�:!>"'�i,>.i!�. �1' �{�F{tL.a vc� s! . . ,+,, 11� ,; (y��[�•/y��: `(�.{� 'y1N,� :�;•p�- Ih:�'?<W�t�Y�}�kiilil{�iiilf!�{t� ;lil 1µt zt. ;�y..t�t {t!}1'�£sSF fi� �.
<br /> �., :1 f :1 n(llti,!it;t t,lift Ili (n }' Vit,: i�NOT.01 1�441:!:1'+�y�<�r•:�1:T. �!'1i i00 R ,4100, iy� �r>)'ti >., S.f U �(�,lii'( Si'ii4:,'i'C�� �"'x'i ,1`fi I' •�
<br /> '.�. �.,.t.', :...._��:� i..�.-.u.+ u1-'n..,Ys: ...'.i.'b..��:..,s..,a_ :a..t. . :,...:<-„x..,..4..-�..%fit.-.i. .��t• 1 :u.y��'«:rs ua«�...•r�'-r n..tt. t . ,t t .6.i+. .I ,li, .��i� IaI`
<br /> CONTRACT PRICE OF WORK:$ 1 '00 •4'1”
<br /> NUMBER OF DEVICES(if low voltage):
<br /> FIRE ALARM? 0 YES igNO
<br /> ASSOCIATED BUILDING PERMIT#(if applicable):
<br /> DESCRIPTION OF WORK:
<br /> 1"14s-ria t) -t024.r: , G3i >i1-- 6,0, P
<br /> .2"011 )
<br /> 2D10 )204 X%
<br /> •
<br /> OWNER NAME: lb 00 twi , �l TENANT NAME(If Commercial):
<br /> OWNER MAILING ADDRESS: STREET 602 V 104)25,55 ,ba,• n^
<br /> Cn•Y�/ STATE vJ/A� ZIP ig20 3
<br /> OWNER PHONE:1416- 124- /811 'OWNER EMAIL:
<br /> CONTRACTOR NAME: 2 vP)# I'V)j'
<br /> CONTRACTOR ADDRESS: STREET b2 5". .5191211&14 �!
<br /> cm gW�,Ln 1 1� ° STATE 144 zlP {BZ 3
<br /> CONTRACTOR PHONE:36�).31 I•t l `CONTRACTOR EMAIL: 401,4aF40.4 RAto rat,/,-loft/
<br /> CONTRACTOR LIC.#(REQUIRED): 040. n.y4140IDN CITY OF EVERETT BUSINESS LIC.#(REQUIRED):45743
<br /> PRIMARY CONTACT: ❑OWNER ,CONTRACTOR 0 OTHER(Please Specify)
<br /> CONTACT NAME: ., CONTACT PHONE: .;bip ?II is 84 ,,:1
<br /> D10/0 IA/0 t y t.lu CONTACT EMAIL: ( ( a 1' w►w ' we.. , .„bp.,
<br /> AGREEMENT:T hereby certify that I have reed 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 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 /> FEE
<br /> D-\AA
<br /> PERMIT#
<br /> t ri ,�' E (�?) C t \
<br /> Owner/Authorized Agent Signature ate (Revised 1011212015)
<br />
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