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#111111°' 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 tx@everettwa.gov www.everettwa.gov/permits <br /> PROJECT ADDRESS: <br /> tUILDING AREA(if residential,new construction,remodel or lor) SF <br /> BUILDING TYPE: 0 SFR-DETACHED ❑ SFR-ATTACHED ❑DUPLEX ❑MULTI-FAMILY-!OF UNITS: 0 COMMERCIAL <br /> USE OF BUILDING: <br /> CONTRACT PRICE OF WORK: $ <br /> NUMBER OF DEVICES(If low vol g ) <br /> FIRE ALARM? 0 YES <br /> 0 NO <br /> ASSOCIATED BUILDING PERMIT ft(if applicable)- <br /> T Iii{a ee <br /> --- <br /> > <br /> ,________CgAti iCe-,14e4"*. 2— /tom OAA.c0 <br /> ...... ,,,,,,,,,y <br /> OW RNAME A '' t� ' A " m TENANT NAME If-Commercial�`em s( <br /> OWNER MAILING ADDRESS: STREET Q.S. <br /> t <br /> STATE \+ ZIP9 82D I <br /> OWNER PHONE: � <br /> rid �� 1t?idVI�ER EMAIL <br /> ,CONT3 AOT& NAME: CP t ^ :fl 9 <br /> CONTRACTOR ADDRESS: STREET 1 1 t0 <br /> :,..' CITY t �x <br /> STATE Yth ZIP <br /> CONTRACTOR PHONE: Zvi. <br /> cOI T`RACTvR EMAIL: joie . :0,40y1110,44-7tc . ,c 11114 <br /> ...�.,0-O' ',7' a.: =8 0 tREylr7,) � 'aRE7r a <br /> s a' �;OF EV BUSINESSLTC.#EREOUIRED); 0 0 .. <br /> PRIMARY CONTACT: ❑OWNER 'A:CONTRACTOR 0 OTHER(Please Specify) <br /> - <br /> CONTACT NAME: CONTACT PHONE: <br /> Q§ 954t <br /> ... :" �� CONTACT EMAIL:. 1I <br /> AGREEMENT:I hereby certify that i have read and examined(his application and know the same to be true end Correct. All provisions of laws end 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 slate or <br /> local law regulating construction or the performance of construction. That 1 am authorized by the owner of this property to perform the work for which application is made end 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 /> poa ' <br /> �- ; f <br /> Own ‘g <br /> E 1,2O - �� <br /> erFA4thofl d Agent SIgnature <br /> - bale <br /> (Revised 9/23/2016) <br />