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4LT _ECTRICAL PERMIT AI*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 I www.everettwa.gov/permits
<br /> 4It i�ni ,�- , ir;' i Ali,„�; 14� Fir.... i �,�� il�`urr��liu li �=���,.,,ri �.�e. �- io-,... ,�, ,�,_ __, ,,.,a, ... �.,�Gtl !;r��;s�r:�� -- �' h µ �,K "�fir” ._
<br /> 4 {� , �` I R ',;— �. i k Li r % .r.l ra j i� i C mai r 7' Ilti '�r.a�Fi
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<br /> PROJECT ADDRESS:-6\01 C.,6\1>i -1-\Q•12.)
<br /> BUILDING AREA(if residential, new construction, remodel,or addition) SF
<br /> BUILDING TYPE: o SFR-DETACHED o SFR-ATTACHED
<br /> FR-ATTACHEED o DUPLEX
<br /> UPLEX o MULTI-FAMILY-#OF UNI,TfS: )(COMMERCIAL MERCIA
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<br /> USE OF BUILDING: t & \\6sy\on /Co w-c,iof( (GV`Gkk -- o ,v Nok-kr\oC
<br /> a ,,,„ rhl 1 v H l E ECTiRICAcAPPLICATIONINFORATIOh Ii ipn: nn s¢r , KI
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<br /> CONTRACT PRICE OF WORK:$1Q
<br /> NUMBER OF DEVICES(if low voltage): \
<br /> FIRE ALARM? (YES o NO
<br /> ASSOCIATED BUILDING PERMIT#(ififapplicable): ,^�nn C (��
<br /> DESCRIPTION OF WORK: 1Y1 `J�\, ak c Q (,� � (Re /c.) Mcy r
<br /> '\Y\ Ate, \ AcQ coon() .
<br /> < '; %.:'` ` n w. ,Ar,----11 ,',-.0 O ITACT INFORMA ION>.,, .-.. '"r �I (w � ,N,,. t,,,
<br /> OWNER NAME: t TENANT NAME(If Commercial):\A ^"ptcci iii\ coif*te,
<br /> OWNER MAILING ADDRESS: STREET Pe (� �V, x'� \5 � V
<br /> CITY�'`�j�'.J +C) L(2 STATE WA ZIP '9.0
<br /> —19
<br /> OWNER PHONE: 1` 'OWNER EMAIL:
<br /> •,� . ._ , , ._mem �-�.. �� �
<br /> CONTRACTOR NAME: CI onora CEr\ Se,Cor L\-\1
<br /> CONTRACTOR ADDRESS: STREET f F) '° ,� ) � / `.l
<br /> CITY 2'1ga/ �\ 1(G STATE WA ZIP 9 6 /O�/�
<br /> CONTRACTOR PHONE: U (CV-f 5 CONTRACTOR EMAIL:
<br /> CONTRACTOR LIC #(REQUIRED): ICITY OF EVERETT BUSINESS LIC #(REQUIRED),003
<br /> PRIMARY CONTACT: o OWNER o CONTRACTOR3.-OTHER(Please SpeciIsfy) I �'I
<br /> CONTACT NAME: CONTACT PHONE:( (Q . 13,, C , `E'_c5
<br /> > v , CONTACT EMAIL: \eAAD\ A `, , Y`oxci.,. art-h. 1 CC1111
<br /> AGREEMENT.'I hereby certify that I have read and examined this application and know the same to be true and cor- . Al .rovisions of laws and ordinances governing this type
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<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 /> ... ."1"y"\.........71\........ PERMIT# ,
<br /> (Wg3I \g ► E 1 gee" a ®a /_-,---)
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<br /> Owner/Authorized Agent Signature Date (Revised 9/23/2016) LI
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