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tLECTRICAL PERNIIT AP�ICAT�ON <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />(P) 425-257-f3810 � FAX 425-257-8857 �(E) everetteps@everettwa.gov � www.everettwa.gov/permits <br />ELECTRICAL APPL[CATwON {NF�RMATIQN <br />CONTRACT PRICE OF WORK: $ ��i'�y�, f�!` �;, r,'<' <br />NUMBER OF DEVICES if low volta e: ~--- <br />FIRE ALARM? ❑ YES 'NO <br />ASSOCIATED BUILDING PERMIT # if a ticable : <br />� y <br />DESCRIPTION OF WORK: f� ,� f.<` �4 �` r � tt.':`�� (���'r�i �-f � �':�� r�.. ��1 tG ' � '� � G�� .:_, � ��;'t. J ' s„','` <br />C�NTACT INFdRMATMON <br />. . ......«-p e ... .,. . .... . . <br />OWNER NAME: iENANT NAME If Commercial : �•�" �� �-- � {� '� � � ' %� � <br />OWNER MAILING ADDRESS: srFeEer <br />CITY STATF 71P <br />� O'V1fN�R PHONE: `,� �` j " �� `� -� �`� � ' ��' � �� �/ OWNER EMAIL: <br />CONTRACTOR NAME: , � r: 3;, � ! r' i � �� f ; <�' O�- Pi:'���� � c ` f� � r i , a - � � /ty , <br />CONTRACTORADDRESS: sracEr �-' ,ti(� .1� �� c; ,�'�` g,�o: �3��.' � �,`�; "��t �(..3- <br />"+ ,, r. <br />CITY j � �,, 1.. � �� � �.. STA7E � ZIP �, u� '. � <br />'.f ; '` l�: �` �/ (� ,� �'L' CC3NTFtACTt7R EMAiL: � � �� '�`' ;, ,%� ' +�, '" 1 . � - <br />C�N7RACTOR PHONE: • - - 1, � •� xt a.� t( c , f'. : <br />r-- ,. <br />CONTRACiOR LIC. #(REt�U1RED). �" E� ��t�l��,C t� + -1 � � �j �.� �%.�-r CITY OF EVERETT BUSINESS LIC. #(REQtJIRCD): �`� `� � ' ' ����� <br />- ` �:a `� <br />PRIMARY CONTACT: ❑ OWNER (�'CONTRACTOR ❑ OTHER (Please Specify) <br />CONTACT NAME: CONTACT PHONE: tr! ,�.-," fu {_ %� j-�, �� t� z-' <br />%`�, f��� r ��` _' �:�, 4 < :,� + �F_�� CONiAG'i EMAIL: �; ��� �Y�/ ��%� �i'.� ��3 -�-,�� �' � /f %(� i .0 �" � �-� <br />AGREEMENT: T hereby certify that / have read and examined this application and know the same to Ae true antl correct. Al� provrsions or iaws ana orainances govern�ng tnrs <br />type o/ wo�k will be completed whether specified herein or noL The granting of a permrt does not presume to give authority to violate or cancel the provisions of any other state or <br />local law regulafing conslruction or the performance of construction. That ! am authorized by the owner of tt�is property to perform [he work for which applicafion is made and I <br />comply with the State Contractors Law 18.27 RCW and 296.200 WAC. <br />�` ' ' l` r,� <br />�� � �� <br />j�.,t� r'�lc.l �" �s:r. � ��g t: t ��-L -�°a_ , � �,,,� , � <br />r <br />OwnerlAuthorized Agent S`ignature Date <br />Gity of Everett Oflicial Use Only <br />FEE <br />��� ���. <br />PERMIT # <br />E ���c�`�-�c���� <br />(Revised 10/1212015) <br />