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477, _ECTRICAL PERMIT A_-LICATION
<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 www.everettwa.gov/permits
<br /> - PROJECT SITE INFORMATION
<br /> PROJECT ADDRESS: /3 yJ vfn Aign,.,,� Ave
<br /> BUILDING AREA(if residential, new construction, remodel, or addition)- 'd (0 SF
<br /> BUILDING TYPE: 0 SFR-DETACHED WSFR-ATTACHED 0 DUPLEX 0 MULTI-FAMILY-#OF UNITS: 0 COMMERCIAL
<br /> USE OF BUILDING:
<br /> CAL C
<br /> ELETRIA
<br /> � PPLICATION INFORMATION
<br /> CONTRACT PRICE OF WORK:$ /ZS'
<br /> NUMBER OF DEVICES (if low voltage):
<br /> FIRE ALARM? 0 YES lig'NO
<br /> ASSOCIATED BUILDING PERMIT#(if applicable):
<br /> DESCRIPTION OF WORK: gedC (,� /6, (oa,•�c..
<br /> CONTACT INFORMATION
<br /> OWNER NAME: TENANT NAME(If Commercial):
<br /> OWNER MAILING ADDRESS: sTREET 'ii .- ,1- ,4i1
<br /> CITY 6.0 yya/'o t77' STATE,�J A-, ZIP
<br /> OWNER PHONE: OWNER EMAIL:
<br /> CONTRACTOR NAME: ;(,V eSii .o l7'1 tLC
<br /> CONTRACTOR ADDRESS: STREET 6/3 Z
<br /> CITY mA-0-6cif kt-e STATE ZIP 9e Z-70
<br /> CONTRACTOR PHONE: Q ,pv CONTRACTOR EMAIL:-1.,A e6r69 wce'G.'i,///az—
<br /> CONTRACTOR LIC.#(REQUIRED): 14)aSTGek_9'-77oK1 CITY OF EVERETT BUSINESS LIC.#(REQUIRED): VS-7 26,/
<br /> .�,,�,.,�..�,�.�.....R.�__.�_.��,.x.�s_,a..r..,.......,n..���........n.....�w��_M__,.�.u..,,,.`.n._._� ...�.�..w.r.. r,..�_.,..w..,..�.�.��,..,,�_a..,,�...,.o._,_n...�..�_,.-�..�...�. . .�.,..._...,._.-..._.�w.. ,_..�....�..�...,_„
<br /> PRIMARY CONTACT: 0 OWNER SI CONTRACTOR 0 OTHER(Please Specify)
<br /> CONTACT NAME: CONTACT PHONE: 3‘,0•
<br /> crrr CONTACT EMAIL: 5-Gce ter
<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 /> 4 01,t)
<br /> PERMIT#
<br /> E r
<br /> Owner/Authorized Agent Signature Date (Revised 10/12/2015)
<br />
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