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ellIP ELECTRICAL PERMIT APPLICATION
<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
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<br /> PROJECT ADDRESS: Z ,) 06 3 S
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<br /> BUILDING AREA(if residential, new construction,remodel,or addition) SF
<br /> BUILDING TYPE: R-DETACHED 0 SFR-ATTACHED 0 DUPLEX 0 MULTI-FAMILY-#OF UNITS: 0 COMMERCIAL
<br /> USE OF BUILDING: !e-, .‘'.04.--..It;
<br /> I CR#GA. ' .MCA i '111F AQ3�kR l `� .N,W. $ ; ,M,,,,
<br /> CONTRACT PRICE OF WORK:$ GI0
<br /> NUMBER OF DEVICES (if low voltage):
<br /> FIRE ALARM? 0 YES ANO
<br /> ASSOCIATED BUILDING PERMIT#(if applicablei):
<br /> DESCRIPTION OF WORK: L-,kG N L: ,e._ 6'4 r ,t-,..,1.,�Lr u� i dA f
<br /> -', .CONTACT INFORMATION ,
<br /> OWNER NAME: gL.,,...,, g4,4 47$ TENANT NAME(If Commercial):
<br /> OWNER MAILING ADDRESS: STREET Z re) S7,t cS't c.c.-u-"'
<br /> �cm,' E L g..,'--,...... hit. STATE ‘....,••••1"1- ZIP 5T-2-03
<br /> OWNER PHONE: 14) Go 6-51S— 6 7d / OWNER EMAIL:
<br /> CONTRACTOR NAME: ,4/L.—dy f -.'Y'G-- & &/frl« {:L
<br /> CONTRACTOR ADDRESS: STREET 9�//J�7Zc) /y/' l d 7`S cf lie 3
<br /> CITY ) r-.J `0. STATE 1 _ - ZIP 5-)(rQ(S 7
<br /> CONTRACTOR PHONE: Za C ;3 75'Zo CONTRACTOR EMAIL: R ,..,.z..-e.... ( .../.0/Gv i�J-i'`- c ...u'�
<br /> CONTRACTOR LIC.#(REQUIRED): 441"Z(--4---:A.` C-4 e- Q CITY OF EVERETT BUSINESS LIC.#(REQUIRED):
<br /> PRIMARY CONTACT: �VVNER 0 CONTRACTOR 0 OTHER(Please Specify)
<br /> CONTACT NAME: CONTACT PHONE: 2_0(o I-Sr 6 7 v
<br /> Ie� /,_, G, i9 CONTACT EMAIL:
<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 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 /> E k$t - 030
<br /> Owner/A orized Agent Signatur- Date (Revised 9/23/2016)
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