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<br /> ECTRICAL PERMIT AUl1CAT1ON
<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 I www.everettwa.gov/permits
<br /> PROJECT SITE INFORMATION`
<br /> PROJECT ADDRESS: s r//‘E,,/ o✓o1-/Z ) At/ e- --,1-6--17---
<br /> --, -1r c-3A, 95 10 l
<br /> BUILDING AREA(if residential,new construction,remodel,or addition) SF
<br /> BUILDING TYPE: 0 SFR-DETACHED 0 SFR-ATTACHED 0 DUPLEX 0 MULTI-FAMILY-#OF UNITS: 0 COMMERCIAL
<br /> USE OF BUILDING:
<br /> ELECTRICAL APPLICATION INFORMATION
<br /> CONTRACT PRICE OF WORK:$ /5-6,c
<br /> NUMBER OF DEVICES(if low voltage):<
<br /> FIRE ALARM? 0 YES jg NO
<br /> ASSOCIATED BUILDING PERMIT#(if applicable): \11 0 15-
<br /> DESCRIPTION OF WORK: ///f,-.,;✓ 41..71Z. , .,-)vi 7,4 v,..))/6,7 4.,o0"- s�Ge,A".o4,
<br /> /vC7
<br /> v 4.---/ z, Q n.�' -L, 1
<br /> $e P, �7-N.e, / / .
<br /> CONTACT INFORMATION
<br /> OWNER NAME: 4�i2 i / Co/ 4.,,,...) TENANT NAME(If Commercial):
<br /> OWNER MAILING ADDRESS: srREEr ',y/8 A Jz.
<br /> O, f)" /-(/C`
<br /> CITY G t 7j ' STATE G.11ta , ziP Z 0/
<br /> OWNER PHONE: OWNER EMAIL:
<br /> CONTRACTOR NAME: �c"g�S •�1-<-- .e-/,26-71i,'- I Se,"IJ,?..a,S (r)279•
<br /> CONTRACTOR ADDRESS: STREET /C/7/�'j Z(-6' G/, ,�f
<br /> CITY 0(1i/A// (s--,A< STATE (n)A- ZIP ?0G/9
<br /> CONTRACTOR PHONE: .- '5 7–6?9 5' • CONTRACTOR EMAIL: .e'a,ST„/5/ci{,eie G-/i, ;,e,,y�S'A,), Go P\.,
<br /> CONTRACTOR LIC.#(REQUIRED): 6-45. s 6t//fir CITY OF EVERETT BUSINESS LIC.#(REQUIRED):
<br /> ..�,....<,.K_w.-.w �... .,, �..,: ..v__. ,,.�.v ..«._
<br /> PRIMARY CONTACT: 0 OWNER [CONTRACTOR 0 OTHER(Please Specify)
<br /> CONTACT NAME: / CONTACT PHONE: V�5•7_3s /�--5-9SS—
<br /> /..eti.7-"" //gip ) S CONTACT EMAIL:
<br /> AGREEMENT:T hereby certify that!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 I 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 bp
<br /> 4 00,--/
<br /> PERMIT#
<br /> ,fr---1.-- / E lel c i - O
<br /> 0 er/Authorized Agent Signature Date (Revised 10/12/2015)
<br />
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