|
ELECTRICAL PERMIT APPLICATION
<br /> Niolg• 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 /> ,- 5 \ z xc;\q .k�4 S A ''' a ti�i`a - h t '*..._ S ^�'�'�:or^�3 \ \ \ri a a; ter..
<br /> -0" d &d*i a _ �`+ 4.l� } � 1R,-yYI� �' I „ , '�'m\.. vT; Z\ U - `.'Z \ \4 -
<br /> �r...�., .;',...W ,,>.. x.,., ka.� .,o., �> �..�, •..L... , _"4, ..:. ..<.,. s.w:,:�.e.. �?.. � ..i;1k.vs�_,u ��..-.,,.., ..a. ,.. �m'�.,>....,.��,.. �.�', � .s�; ` ,.� .'�.�.: ..'c.a>�,�a.t. :
<br /> PROJECT ADDRESS: '-a..4 Zr,c\,(P ,kL.r
<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: S: ..k......._. ••
<br /> ,� (
<br /> J
<br /> f .tf. Q t Z - ,�� � 5 Y
<br /> ? f Yr Y 4 h I.ECArftr f L al p Mi, l�r��cll y .41 11 � k`� � r' f�S k' �h k S T
<br /> � . ...L:�u ... o\.-,,.naa`��:. � ,..��`� ,�.... �. ..x,»�, .<«,�,z _.e. 't.+a, .L�,� r'�. �.R.��_.., x�:,. �� �_ .. \4
<br /> CONTRACT PRICE OF WORK:$ 1) 1 \ ,_,
<br /> NUMBER OF DEVICES (if low voltage):
<br /> FIRE ALARM? 0 YES 0 NO
<br /> ASSOCIATED BUILDING PERMIT#(if applicable):
<br /> DESCRIPTION OF WORK: (-2,1,„-„wt,,,- 1v, ,,, ,,,,ot ,0 L f— ,,:tie (`1t,jv'e
<br /> �-- C cJY�1,(1,=i5,c_ _ i % `
<br /> '_ , 7 Air po j 4-- ( RT..- _ CdA c c am
<br /> CONTACT iwaitMATIION
<br /> OWNER NAME: TENANT NAME(If Commercial):
<br /> OWNER MAILING ADDRESS: STREET
<br /> CITY STATE ZIP
<br /> OWNER PHONE: OWNER EMAIL:
<br /> CONTRACTOR NAME: C .N„0 S.€) (Z f�/�C ,`° /t
<br /> CONTRACTOR ADDRESS: STREET Q iipp & e- �r-}--1
<br /> CITY rik( f ') STATE (,j,4 ZIP /c�
<br /> rl) /�
<br /> CONTRACTOR PHONE: YO' _� t- `�$ CONTRACTOR EMAIL: �Cpc1p s e elec: ,t P Z tc�t ,C'�t�
<br /> CONTRACTOR LIC.#(REQUIRED): CO0 .e II CITY OF EVERETT BUSINESS LIC.#(REQUIRED)416 `;
<br /> PRIMARY CONTACT: ❑OWNER ONTRACTOR 0 OTHER(Please Specify)
<br /> CONTACT NAME: CONTACT PHONE: L Sir) R
<br /> P4----.
<br /> (t \/\ r (AP CONTACT EMAIL: 5--.4'w,P a S vq..cni)
<br /> AGREEMENT:I 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 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 construction. That!am authorized by the owner of this property to perform the work for which application is made and!
<br /> comply with the State Contractors Law 18.27 RCW and 296.200 WAC.
<br /> City of Everett Official Use Only P ��-: i i 1— —')OrX PERMIT#E Vc&l A _Dog
<br /> Owner/Authorized Age tignature Date (Revised 9/23/2016)
<br />
|