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11P
<br /> 0011°P ELECTRICAL PERMIT APPLICATION
<br /> ....... .2.':, - 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@everetiwagav I vvww,everettwagoviperrnits
<br /> 11P4''.:::11,".: AWLMT:41-11tini-;14,?: ;441'!':',
<br /> PROJECT ADDRESS: .675-c: j) 41/1 1,11/664/ Z0,76
<br /> BUILDING AREA(if residential,new construction,remodel,or addition) _
<br /> BUILDING TYPE: E16R-DETACHED 0 SFR-ATTACHED 0 DUPLEX 0 MULTI-FAMILY-#OF UNITS: 0 COMMERCIAL
<br /> USE OF BUILDING: (7.e...ssideea
<br /> ,,,•.', ,,,Azeowf'"Iri` ''14$'464::,,N0-0,1-,AtArl. , oa,,,,, „4,, , y,`,*Irk.,,,,1..,,,,,,,,,. , ,,,p, .,4..,7,« « ,,,, ‘+*v >7%,:,',.:,,."',,,i , , ^',..=" ~-,--/,4%, ",,,' ,.,
<br /> CONTRACT PRICE OF WORK:$ 6*SV 'm
<br /> NUMBER OF DEVICES(if low voltage):
<br /> FIRE ALARM? 0 YES IM6
<br /> ASSOCIATED BUILDING PERMIT#(if applicable): ,04//t#
<br /> DESCRIPTION OF WORK: 1- 17/9-C .--- ‘,01
<br /> ',. ' ,'','.- ..-.A.;----- ,,,-Vw"-°,-,----- ...t="..es.sdLY--141..A•T. ,"j-,,,-...,,,, d,',,'`1,,,'1' '''.'''''''''”..... 0,'"...."'''' ','Z''';'.Me''''',44."VO'' ;,1,,i.M.:t:A.-...-:.---,-,, ,,,, -, ,..", ,, „4,,,,,
<br /> OWNER NAME: /Sey v' re:eirf 1„,csectan1 TENANT NAME If Commercial):
<br /> OWNER MAILING ADDRESS: STREET-5:5;7'c /1 ' I 'IL*4 i
<br /> CITY .„ „„.,,e4.4,6e STATE 0:0441' EP
<br /> OWNER PHONE: 4/e2,5"--* 33.3 —0)g), OWNER EMAIL:
<br /> CONTRACTOR NAME: ' - -1/40-, / a,..
<br /> i
<br /> CONTRACTOR ADDRESS: STREET IS 0,7 S' ttt.57
<br /> crrY .41( "'C'Iy6--- STATE 4:4))14 ZIP 418;)33
<br /> CONTRACTOR PHONE: t,„?. 0— 94 —4K-4 a 7 CONTRACTOR EMAIL: /YeL,e"71700-7(P /-0,4€4,72701. thre'664.-
<br /> CONTRACTOR LIC.#(REQUIRED): Rai-, ...-4,4 6.1.90 j"..)# CITY OF EVERETT BUSINESS LIC.,#MEQUIRED): 443-7e3
<br /> p,6q:
<br /> PRIMARY CONTACT: 0 OWNER „ ONTRACTOR ID OTHER(Please Specify)
<br /> CONTACT NA11E:l$ CONTACT PHONE: 06.4)--3 4?/—/siy
<br /> ,
<br /> e CONTACT EMAIL: i ,..,„1„,„4., e
<br /> AGREEMENT:Thereby certify that I have read and e•--, ined•this application and know the same to be true and=nest. All provisions of laws and ordinances governing this
<br /> type of work will be completed whether specified herein or not. The granting ea permit does not presume to give authority to violate or cancel the provisions of any other statoor
<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 end!
<br /> comply with the Store Contractors Law 18.27 ROW and 290.200 WAC.
<br /> City of Everett Official Use Only
<br /> FEE
<br /> 415. C(
<br /> "\\) PERMIT#
<br /> E 1-/D%- 1 )-1
<br /> Owner/Authorized Agent Signature Date (Revised 1011212015)
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