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<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 1(E)everetteps@everettwe.gov I wwvv.everettvva.gov/permits
<br /> 1-iriN$104; '
<br /> PROACT .5ADDRESS: CI'
<br /> BUILDING-AREA(II residential,new construction,remodel,or addition) SF
<br /> BUILDING TYPE: v' SFR-DETACHED 0 SFR-ATTACHED 0 DUPLEX 0 MULTI FAMILY-#OF UNITS: 0 COMMERCIAL
<br /> USE OF BUILDING:
<br /> H„,,,,orAl eit e*,,117RT-oll,:,/..-rtze.,7,-,;,t, i-- °--
<br /> ,. ., 1--...,6 , - -.4
<br /> CONTRACT PRICE OF WORK: $ (,)
<br /> NUMBER OF DEVICES çw low volts e :
<br /> FIRE ALARM? 0 YES `14 NO
<br /> ASSOCIATED BUILDING PERMIT#
<br /> -_-11Eaceuzciomix,woRKL_ .., fff I pt)41.4
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<br /> OWNER NAME: V i ! rl ' ob/II TENANT NAME fir Conwriarota#:
<br /> OWNER MAILING ADDRESS: STREET 5705 Wthw're,
<br /> ...
<br /> crrr ##$A , 004_
<br /> OWN . ... ..- - STE 17
<br /> RHONAg
<br /> OWNER EMAIL:
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<br /> CONTRACTOR NAME: Al A
<br /> CONTRACTOR ADDRESS; STREET 0 44)0J3
<br /> 1.4 15 W ad
<br /> CITYSQptieot7Ze./1 ' STATE Miite, j Ar ZIP )3
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<br /> CONTRACTOR PHONE 0.§ tkosig .70 0 CONTRACTOR EM/„..k.I...........................______Lt 4I, ''' 0 .if,; ' ' 4111# 411,1„.....401,1 61! t $ 114
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<br /> • S OU RED ZA.,,r nft I rillilVINIRMIIIMIM el . OF ”ii BusiNglits LIC #REQUIRED,' troirliii$31111
<br /> SAMSOMM.....M1.11.40+0,...,,,,,,,a,mrnimmwom...rnmeeta*MeMarrinmumm*I.Mmelervimmooemm,,..0.110.m.........,m01,..mrme.Mesi....a...m.. L.P.'rlem. ,¢0,11¢* Mr: 1 A
<br /> PRIMARY CONTACT: 0 OWNER '4 CONTRACTOR 0 OTHER(Please Specify) - - ------" '
<br /> CONTACT NAME: '
<br /> CONTACT PHONE. r-,f 9 -gmc,
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<br /> 7 CONTACT EMAIL
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<br /> ZR;;;E—N77/hereby —certify that i have read and examined this application end know the same to be true and cOrrect. All provisions of laws end ordinances 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 cancel the provisions of any other state or
<br /> local law regulating construction or the performance of con struction. That I am authorized by the owner of this property to perfondthe work for which application Is made and I
<br /> comply with the State Contractors Law 18.27 RCW end 290200 WAC.
<br /> City of Everett Official Use Only
<br /> PERMIT#
<br /> lebj2i -
<br /> ' -euta, . ,.,. I E k %D - D32
<br /> owitertatAtiwized Agent Signature, Date b
<br /> (Revised 9/23/2016)
<br />
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