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ELECTRICAL PERMIT APPLICATION <br /> CITY OF EVEREU PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> (P) 425-257-3810 I FAX 425-257-3357 ( (E)everetleps@everettwa.gov( www,everettwa.govtpern-r;ts <br /> PROJECT SITE INFORMATION <br /> PROJECT ADDRESS , • <br /> 3UILOING AREA -as,den`;a° r-aw <br /> D � T+:ao �r a:�tF�iCrt Br <br /> 3JIL `ND TypE: ❑ 3 z -� rl <br /> ELECTRICAL' PPLICAT QN imFORMA los <br /> CONTRACT PRICE OF WORK: $ 'C.) eo <br /> NUMBER OF DEVICES if low voltage): --- �; <br /> FIRE ALARM? <br /> 0 YES 0 NO <br /> ASSOCIATED BUILDING' PERMIT#(If a pllcablel: <br /> DES GRIat.IONLOF,I VO IC:.___ _ <br /> is - �tx Y' <br /> doi4 tact IfiPOItI4' O <br /> OWNER NAME: <br /> OWNER MAILING ADDRESS, <br /> CITY <br /> r � <br /> mintelmminnionnommiummiammimmin <br /> 4 , »C 1 AI STAT \A) 0 <br /> ao <br /> >O iT:RADTD NAME: <br /> � td <br /> aNTRACT'J ADDRESS: <br /> Imo( act • - <br /> 'Cry .r. ... STATE q 41) ."-r)�» <br /> CONTRACTOR PHONE: 6 *`•'� �.r * A � zip <br /> CONTRACTOR EMAIL: I .0 �' <br /> Ct7fATR:A'C"I"i�RTl�`"�EO `IRED j;i°. : - orr ►��� • - <br /> � .e�+l 41. i <br /> PRIMARY CONTACT: CITY OF EVERETT BUSINESS LIC,#(REQUIRED); CO 4" <br /> 0 OWN811 <br /> ER rel CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: <br /> CONTACT PHONE: 'U ase <br /> I &ate CONTACT EMAIL eb, <br /> 4/1 <br /> AGREEMENT.1 hereby certify that I have read and examined this application and know the same to be true and correct. A8 provisionsof laws end o�Mi esoverni <br /> of warnwill be completed whether specified herein or not. The granting of a permit does not presume to glve authority to violate or cancel the provisions of any other slate° <br /> local law regulating construction or the performance of construction. That 1 am authorized by the owner of this P roPrty e to perform the 9 ng this <br /> type <br /> comply with the State Contractors Law 18.27 RCW and 296.200 WAC, <br /> work for which application is made and l <br /> City of Everett Cffciai Use Cnly <br /> dl� PERMIT# <br /> to 2 . � <br /> � E <br /> r, i �iD� IpS <br /> CWer/Authprizec!Agent S:gratura • <br /> Cate <br /> (Revised 9123/2016) <br />