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grr 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 I (E) everetteps@everettwa.gov I www.everettwa.gov/permits
<br /> PROJECT ADDRESS:'2,7"t 1 0 v..46tikonAca Av-c,..
<br /> BUILDING AREA(if residential,new construction,remodel,or addition) I,"KA-12-`¶ SF
<br /> BUILDING TYPE: 0 SFR-DETACHED, SFR-ATTACHED 0 DUPLEX 0 MULTI-FAMILY-#OF UNITS: 0 COMMERCIAL
<br /> USE OF BUILDING:
<br /> - EC ' A aP C n f ON K .;. maxrti , st � . e -s#� w � war . 7lKfi ��'. I� �+ l�tA,
<br /> - v
<br /> CONTRACT PRICE OF WORK: $ LP 0 0
<br /> NUMBER OF DEVICES (if low voltage):
<br /> FIRE ALARM? 0 YES 0 NO
<br /> ASSOCIATED BUILDING PERMIT#(if applicable):
<br /> DESCRIPTION OF WORK: 13,A-11/ 4 ,V) rcfotace/fmetAk"
<br /> F - GQNTAGT INFIDRiik O ',4,,,'„013:14,,9,---{K ,fir§ _ l
<br /> ,4,1,174,,,„-„,F4, A oI Iwe ss' HI P ,. s. .@1� ,0, ,p o ani. .,,,,tl, a ,a,,Mti:ii �. 'C,41 ;th ,, 7 r 00 'gym (
<br /> OWNER NAME� � nx
<br /> r7 1� r a�7.---2A)(1� TENANT NAME(If Commercial):�/[ �
<br /> OWNER MAILING ADDRESS: STREET '� Q�",.�V�^0 :A \`�LA-,
<br /> ^� C`
<br /> CITY �/ . �1 `'' 1 STATE�/ A ZIP q. �! ,
<br /> OWNER PHONE: 4-2,c-��-—_ so-93 OWNER EMAIL: VA G
<br /> CONTRALTO... �. ..
<br /> R NAME: a\-A...12._.
<br /> CONTRACTOR ADDRESS: STREET ``, v[J`' "(:5\----'SAP----)
<br /> CITY t - -9\----
<br /> ,/� STATE V i A ZIP 0443
<br /> CONTRACTOR PHONE:'! v� ") \•�\�J C\ `CONTRACTOR EMAIL: V L L O
<br /> CONTRACTOR LIC.#(REQUIRED) 17 1�°� I�� CITY OF EVERETT BUSINESS LIC.#(REQUIRED) C
<br /> , .:...r...., P .,„„.. M .., U._, ,.ry �., Y� ,,a-n. . . ,,���a. Sys- .. . ..,*I,. .
<br /> PRIMARY CONTACT: 0 OWNER /�( ONTRACTOR 0 OTHER(Please Specify)
<br /> CO TACT NAME: CONTACT PHONE:c—;; -—7-1 1. i ( ?
<br /> /n/ 1& v Vi I CONTACT EMAIL:
<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 1 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 /> PERMIT#
<br /> -�-_.� � t E ( <OS-' ©gS
<br /> Owner/Auth. ized Agent Sign4 1210 Date (Revised 10/12/2015)
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