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ELECTRICAL PERMIT AOLICATION
<br /> 411/11//41411'7—°:—A
<br /> ..7 ..1-. 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
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<br /> PROJECT ADDRESS: (40 I P.-671 I net( Ave neirett , VIA CAC:bl 2-0
<br /> BUILDING AREA(if residential,new construction,remodel,or addition) SF
<br /> BUILDING TYPE: 0 SFR-DETACHED ' SFR-ATTACHED 0 DUPLEX 0 MULTI-FAMILY-#OF UNITS: 0 COMMERCIAL
<br /> USE OF BUILDING: Sf
<br /> 4.01kt:n;',.,“, t7t,ryneliirt;'IMIC:',":1rMifittittittitialltiiia7:::AiFt1;447 ":-
<br /> Plosit!Or " ,, ',, kl,n',„".7,'.,' ;,,,° .1.!L:...„74‘,1;',,,,,,,,,,,,-,„„,,;,„,,, ,,;',,,-,•,,,,
<br /> CONTRACT PRICE OF WORK: $ ei5IDO
<br /> NUMBER OF DEVICES(if low voltage):
<br /> FIRE ALARM? 0 YES ENO
<br /> ASSOCIATED BUILDING PERMIT#(if applicable):
<br /> DESCRIPTION OF WORK: W) ,A MO pyl.Q, MA A vie y , (2-) a.\--ttrC4 iti-m/ii--t-
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<br /> OWNER NAME: I'l/1i1( 6-t-tr-n( llit TENANT NAME(If Commercial):
<br /> OWNER MAILING ADDRESS: STREET 11-F0 1 --el Of ni IM
<br /> CITY V--(Ainf- STATE WA- ZIP le-zz I
<br /> OWNER PHONE: 42 . "/ '2. -7 q i==7 ci . OWNER EMAIL: AJ/4-
<br /> 4 .CONTRACTOR NAME: /n too 6-e Fle-24-1//c,
<br /> CONTRACTOR ADDRESS: STREET il .A:-.) 117 7" 012 'Sr
<br /> CITY -A. ke cf-f- 7.-a/7cs- STATE 11/14 ZIP q 2-Sg
<br /> ,
<br /> CONTRACTOR PHONE:/-/-2 --769 0- 32_03 CONTRACTOR EMAIL: /k7epeA/-1(1/1 i(-6--@g kn ta.,1 1 •Ci9-7-,
<br /> CONTRACTOR LIC.#(REQUIRED): /Ni--t-OvES-q9•2A C7 CITY OF EVERETT BUSINESS LIC.#( 6-QUIRED): (Y44/12(e3
<br /> _
<br /> PRIMARY CONTACT: 0 OWNER 0 CONTRACTOR 0 OTHER(Please Specify)
<br /> CONTACT NAME: "cc CONTACT PHONE: .42_G , 0 220 -7q 7 _
<br /> CONTACT EMAIL: ikV ././ 1-7-,r 0,1 a a//
<br /> AGREEMENT:I hereby certify that I have read and examined this application and know the same to be true And correct. All provisions o la s'and vi Ions
<br /> 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 canoe e provislons 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!appiis!cationmade andI
<br /> comply with the State Contractors Law 18.27 RCW and 296.200 WAC.
<br /> ir City of Everett'Jfficial Use Only
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<br /> PERMIT#E 0 - 151D
<br /> offik Air,'
<br /> Ow er/Authorized Agent Si. e•
<br /> i Date (Revised 9/23/2016)''-'
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