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grr ELECTRICAL PERMIT APF LICATION
<br /> CITY OF EVERETT PERMIT SERVICES
<br /> 3200 CEDAR STREET, EVERETT, WA 98201
<br /> (P)425-257-8810 I FAX 425-257-8857 1 (E)everetteps@everettwa.gov www.everettwa.gov/permits
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<br /> PROJECT ADDRESS: I �j O di-
<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:
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<br /> ����t�i P��j���a��,i,i (dill hijotl�I����,-'g',°j I iilj�6�it �j�'jl'i rt'9a'` lui (�� G �iW; it �j ) (' �.,. v ,:j' t lid �il�l"4, �e ,.0`t.^.19 ri atk
<br /> .,:� y � k �, , I li I.I �! G� INFORM, f
<br /> CONTRACT PRICE OF WORK: $ IOC
<br /> NUMBER OF DEVICES(if low voltage):
<br /> FIRE ALARM? 0 YES 0 NO
<br /> ASSOCIATED BUILDING PERMIT#(if applicable):
<br /> DESCRIPTION OF WORK: -�DQ.- --S474 ±1), f . 461)fay
<br /> C STAT INFORMATION
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<br /> OWNER NAME: alt, C� ,e 2 17C) TENANT NAME(If Commercial):
<br /> OWNER MAILING ADDRESS: STREET 34. 1f) 1/\\ n /,
<br /> CITY Op CSNat* STATE WA, ZIP ti4-x/44
<br /> OWNER PHONE: 4• \ • p�,,,5 OWNER EMAIL:
<br /> CONTRACTOR NAME: % AD(YR., awn. un-S.
<br /> CONTRACTOR ADDRESS: STREET i 1r` (1,.� 19 IS,
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<br /> CITY N\ �Q STATE Wt/,- ZIP U�
<br /> CONTRACTOR PHONE: 3l.eO•Le 9C ® CONTRACTOR EMAIL: )(( P-4tV1 fa- r\ . 0.6Y1n
<br /> CONTRACTOR LIC.#(REQUIRED) P1 C
<br /> 4 LPK--P CITY OF EVERETT BUSINESS LIC #(REQUIRED): 1)6"` 05S
<br /> PRIMARY CONTACT: 0 OWNER 'CONTRACTOR 0 OTHER(Please Specify)
<br /> CONTACT NAME: CONTACT PHONE: Np0 .E.Qc& .966 0 ,,I
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<br /> AGREEMENT'I hereby certify that I have read and examined this application and know the same to be true and correct. All prowsi s of laws and ordinance overning 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 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 /> PERMIT#
<br /> 41d
<br /> �� c$ E - 239
<br /> Owner/Au-Owner/Auj orized A.ent Signature Date (Revised 9/23/2016)
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