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<br /> ELECTRICAL PERS IT APPLICATION
<br /> CITY OF EVERETT PERMIT SERVICES
<br /> 3200 CEDAR STREET, EVERETT, WA 98201
<br /> (P)425-257-88110 J FAX 425-257-8857 I (E)everetteps(everettwa.govvwvw.everettwa.gov/permits
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<br /> PROJECT ADDRESS: 49-2'5- edeziz Aft) m -1/
<br /> BUILDING AREA of residential,new construction,remodel,or addition) SF
<br /> BUILDING TYPE: El SFR-DETACHED ❑SFR-ATTACHED ❑DUPLEX El MULTI-FAMILY-#OF UNITS: NI COMMERCIAL
<br /> USE OF BUILDING: 41,OT`s' , EV,e_E T -
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<br /> CONTRACT PRICE OF WORK:$ 92/0.00 •
<br /> NUMBER OF DEVICES(if low voltage):
<br /> FIRE ALARM? ❑YES 14 NO
<br /> ASSOCIATED BUILDING PERMIT#(if applicable):
<br /> DESCRIPTION OF WORK: 4Z4` /242,9).14.441,..j /Vt. GOD-Zt
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<br /> .A._!4• 421,0 •
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<br /> OWNER NAME: TENANT NAME(If Commercial): bt)
<br /> OWNER MAILING ADDRESS: STREET• Pa Pax 37,7 �(
<br /> CI'( 5tE' 'r'�,G~' STATE 441 ZIF@,6/2/{2267
<br /> OWNER PHONE: OWNER EMAIL:
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<br /> CONTRACTOR NAME: /(,&-Iv t[... eily rguee)/0
<br /> CONTRACTOR ADDRESS: STREEr Po Lox 4/10 h/�_l
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<br /> CITY ))n14 /L.T.Z2 STA1TE � ZPgg2,0
<br /> CONTRACTOR PHONE 426'2/4-4144 CONTRACTOR EMAIL: kA--J�1. FH4iimLEle4) &/Y)
<br /> CONTRACTOR LIC.#(REQUIRED): GDNele Oz CITY OF EVERETT EiUSINESS IJC.#REQUIRED): 0�
<br /> PRIMARY CONTACT: ❑OWNER 151 CONTRACTOR Cl OTHER(Please Specify)
<br /> CONTACT NAME: Cep . CONTACT PHONE: 204,-736-%54-(per •
<br /> . ��J J 5 ep(N1 CONTACT EMAIL: pi NAI IS.6A,01416A,0141O l�.it..w/iT. d.Dni
<br /> AGREEMENT:T hereby certlly that l have read end examined this application and know the same to be true and correct. Ad provisions of laws and ordinances governing This
<br /> type of work will be completed whetherspecilted 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/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 206200 WAG.
<br /> City ofEverett Official Use Only
<br /> FEE
<br /> W. 57
<br /> •
<br /> •
<br /> PERMIT
<br /> E 1.V.0 - 0(b&
<br /> Owner/ u or ed Agen Signature Date (Revised 10/12/2015)
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