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OtEETT ELECTRICAL PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> (P)425-257-8810 1 FAX 425-257-8857 1 (E)everetteps@everettwa,gov www.everettwa.gov/permits <br /> PROJECT SITE:INFORMATION <br /> PROJECT ADDRESS; I-4 RQ/ r ' Ave, t • <br /> , { <br /> BUILDING AREA(t rssidentia',now�:Jns u ;on >,ypisq,orad�di.tiionl SF <br /> 911ILDIN3 TYPE: 3 R-DETAD-tEU . <br /> �-: A 4^�+=D ❑DUD' =X 0 i41UC_T1-;=AMlLY-tt OF UNITS 0 VOtuti49EP'"` <br /> U.S"OF BUILDING; <br /> CONTRACT <br /> ELECTRICAL,APPL1GIr TION' NI O IVIAtIO� <br /> PRICE OF WORK: $ '0 ,cc. <br /> NUMBER OF DEVICES (If low voltage); <br /> FIRE ALARM? 0 YES 1.0° <br /> ASSOCIATED BUILDING PERMIT#(it appllvablel; <br /> _ OESCRIETIO .CtEWORK <br /> CONtA r I roRI �rgat <br /> OWNER NAME: riot •f ''.) <br /> TENANT NAME If Commercial <br /> OWNER MAILING ADDRESS; S RE=T cioq 2 1 <br /> fiL�� <br /> t <br /> .t� STaT=- AL z17' aMs 203 <br /> OWNER PHONE: 9 dr r ° o OWNER EMAIL: <br /> a" NiTRAZTOR NAME: Akt r. • tt <br /> :.ONT.RACTOR ADDRESS: i ,,t.f y <br /> LA- <br /> 3T,! =T tC 4�E)�.i <br /> CIN •'°A A- ZIP q �,L,./ I <br /> STATE <br /> CONTRACTOR PHONE: s, .At'�"1 .740 CONTRACTOR EMAIL: <br /> _.. C�TRTR.A(,`T01�-[T�.,'�E�..! ft�'FD : '"1 .t1/ 4. !' � r i /14- } �n � � CITY OF EVERETT BUSINESS LIC.#(REOIJIRED: r <br /> PRIMARY CONTACT: 0 OWNER ►j CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: <br /> ��f y n CONTACT PHONE: 35, <br /> k '�:/�0-10IC. CONTACT EMAIL: ( ; lI con-) <br /> AGREEMENT:I hereby certify that I have read and examined this application end know the same to be true end Correct. Alf provisions of laws and ordinances governing this type <br /> of work wilt 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 5tate Contractors Law 18.27 RCW and 296.200 WAC. <br /> City of Everett Official Use Only <br /> PERMIT# <br /> 4e1:2 10e-- al/al E ( 0- 0/7 <br /> OvinertAuthcjriZed Agent+lgnaturs Cal <br /> « <br /> le (Revised 9/23/2016) <br />