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E CTRICAL PERMIT AP
<br /> /1144%*F---'4CITY OF EVERETT PERMIT SERVICES N, 11,1.:L
<br /> proiii il
<br /> 3200 CEDAR STREET, EVERETT, WA 9820hi
<br /> (P) 425-257-8810 I FAX 425-257-8857 I (E) everetteps@everettwa.gov I www.everettwa.gov/permits
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<br /> PROJECT ADDRESS:J(Ai\ iiiti cg I
<br /> BUILDING AREA(if residential,new construction,remodel,or addition) r ,C%his' lla SF
<br /> BUILDING TYPE:ZrSFR-DETACHED 0 SFR-ATTACHED 0 DUPLEX 0 MULTI-FAMILY-#OF UNITS: 0 COMMERCIAL
<br /> USE OF BUILDING:
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<br /> CONTRACT PRICE OF WORK:$ (gaO
<br /> NUMBER OF DEVICES (if low voltage):
<br /> FIRE ALARM? ❑YES ❑NO
<br /> ASSOCIATED BUILDING PERMIT#(if applicable : 1/
<br /> DESCRIPTION OF WORK: 1(�,Q, Q f-.v -P/}/i ..e v doh
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<br /> �I Ji �o l I ( - '�i�����I t.�3 1�1'Mi'����' '-�j (�.�� of ! 311°Ib(�� ,Kice' { * L.711
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<br /> OWNER NAME: Care((? Cv? A TENANT VAME(If Commercial):
<br /> OWNER MAILING ADDRESS: STREET 'p1` b
<br /> cITY r (.t�EP STATE ZIP q )7A'Q5
<br /> OWNER PHONE: — 3t1 ,�7(,A le OWNER EMAIL: 4 d •
<br /> L Si.',1— (0 A I 141114 i 44ii
<br /> CONTRACTOR NAME: 10.e am
<br /> CONTRACTOR ADDRESS: STREET 7„rn �j7,J4/�5 F )C(1 #1
<br /> CITY 1J`eU '7 t�y ` '-- roc -.. STATE 7 ZIP gap
<br /> CONTRACTOR PHONE: "%b— '7 — /r3 CONTRACTOR EMAIL: 1' r P 7/�/ /VTZ }P -
<br /> CONTRACTOR LIC #(REQUIRED): U/�f! F 3 46` 1 CITY OF EVERETT BUSINESS LIC.#(REQUIRED): D_.
<br /> PRIMARY CONTACT: 0 OWNER CONTRACTOR ❑OTHER(Please Specify) ���
<br /> CONTA T NAME: CONTACT PHONE: �I U _(.. i
<br /> ,,----c,
<br /> antro \-)06-KtOe,_ CONTACT EMAIL: f O bi "� nAGREEMENT T hereby certify that I have rekc,and exais 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 lam 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 /> t /b10 PERMIT#
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<br /> J1I
<br /> � E ISvi—OSI
<br /> 0 er/ hor Signature Dat (Revised 10/12/2015)
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