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ELECTRICAL PERMIT APPLICATION
<br /> CITY OF EVERETT PERMIT SERVICES
<br /> 3200 CEDAR STREET, EVERETT, WA 98201
<br /> (P)425-257-8810 ( FAX 425-257-8857 � (E)everetteps@everettwa.gov� www.everettwa.gov/permits
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<br /> PROJECT ADDRESS: 3�zS co,.s3 v�
<br /> BUILDING AREA(if residential,new construction,remodel,or addition) SF
<br /> BUILDING TYPE: ❑SFR-DETACHED ❑SFR-ATTACHED ❑DUPLEX ❑ MULTI-FAMILY-#OF UNITS: COMMERCIAL
<br /> USE OF BUILDING: $ o�p��
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<br /> CONTRACT PRICE OF WORK: $ 5�� -�'—`�-
<br /> NUMBER OF DEVICES if low volta e : �t'lo
<br /> FIRE ALARM? YES ❑NO
<br /> ASSOCIATED BUILDING PERMIT# if applicable :
<br /> DESCRIPTION OF WORK: )�t5�'��t,. A�L�s5AE3L�.. vaw A+c Fi2S,.. S . �a,
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<br /> OWNER NAME: eo4Qy p��,�yi��L 63�i�, TENANT NAME(If Commercial):
<br /> OWNER MAILING ADDRESS: sTReeT
<br /> CITY STATE Z�P
<br /> OWNER PHONE: �lZS 339 3�038 OWNER EMAIL: j�LL?pN S�.C.taA3 'f,c,t7y1.,
<br /> CONTRACTOR NAME: f3 � }E j�iL4„ g� 5k.Lv211' L..�.�-
<br /> CONTRACTOR ADDRESS: sTReer Qp 63px 3 1
<br /> CITY /�Q(,,.��(�,'�`OtJ STATE WA 21P 9QZ23
<br /> CONTRACTOR PHONE: �''��S Zr4�{ I�f�� CONTRACTOR EMAIL: ��rF�, QN H Fl�-•�YY"1
<br /> CONTRACTOR LIC.#(REQUIRED): ��'F)I�H�'$YZ kVJ CITY OF EVERETT BUSINESS LIC.#(REQUIRED):p�Srv ,
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<br /> PRIMARY CONTACT: ❑OWNER �CONTRACTOR ❑OTHER(Please Specify)
<br /> CONTACT NAME: CONTACT PHONE: �2,r� y f� �yy�'
<br /> S�fY SR.�Sy�btt� CONTACT EMAIL: S�.F Ce°.�Nf1F1��. . G�clY`"�
<br /> AGREEMENT.�T hereby certify that I have read and examined tAis application and know the same to be true and correct. All provisions of laws and ordinances goveming this
<br /> type of work will be completed whethe�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!aw regulating construction or the performance of consfruction. That 1 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 RC W and 296.200 WAC.
<br /> City of Everett Official Use Only
<br /> FEE
<br /> a�a-So
<br /> PERMIT#
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<br /> Owned orized Agent Signature Date (Revised 10/12/2015) /
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