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� <br />� <br />ELECTRICAL PERMIT APPLIGATION <br />CITY flF EVERETT PERMIT SERVIGES <br />32Q0 CEDAR STREET, EVERETT, WA 98201 <br />(P} 425-257-8810 � FAX 425-257-8857 �(E) everetteps '�,,aj. everattwa.gov � wwNi.everettwa.gov/permits <br />� -� '' ' � � .. i>itt�:lE�`r�"'SI�"E ���t��fiA'1"�t1f+�� � <br />�'� '� e °���' � <br />s.. � <br />PROJECT ADDRE9St u � ��, , � � � ,� <br />E �'-' <br />BUILDING AREA (t residentiai, new construction, rEmodei, or addition) � gF � <br />BWLRING TYPE; � SFR-0ETACHED � SFR-ATTACHED ❑ pUPLEX ❑ MULTI-FAMILY -# OF UNITS: OMMERCIAL <br />IJSE O�' BUILDING: �� �,�"�rq i`¢�. .°-s �Cr` , s � S? <br />ELEG1 <br />CONTRACT PRICE OF WORK: S <br />NUMBER OF DEVIGES {if low voltaqe)� <br />FIRE ALARM? �_�$ ❑ Nd <br />ASSOCIATEp BUILDING PERMIT # (if applic <br />DESCRIPTION OF 4YORK: i'� `�Y� �`iG:� <br />_ <br />OWNERNAME: { ._� `�� �• ��: �r` <br />�WNER MAiI.ING ADDFtE3S: sr�teer <br />arv � <br />�WNER PHONE: <br />:ONTRACTOR NAME: l�.�� +� v�; t`!t f <br />�' . �", > C,`:`= <br />EMAtL: <br />� <br />S7A7f <br />ZIP <br />+•���a�MVI\LOJ: S p' ' .... y._.. <br />.TREET <br />� ( d� � ,.. <br />CI'Y i 5•` . ,_ �. r ['" '� �""'` <br />STA7E ' ,: � ZIA ` �,✓� r <br />CONTRACTOR PHONE: ;.. � � j 'g'�� " �� CONTRACTOR EMAIL:� -, �,` h . �r, � � p �� <br />` a:�-� ` . <br />CONTRACTOR LIC. #(RE�UIRED): "- ,t � ' i�,�,�.� � � CI7Y OF EVEF2ET7 8USlNESS UC, A'(REQUIRED); �� � � `',�' <br />PRIMARY CQNTACT: �gl�/NER ❑ CONTRACTOR ❑ OTHER (Please Specify) <br />_ <br />CONTACT NAAA6; COMTACT PHONE ° �°c � ' _ ✓ � - i '"� +=�g =`l <br />� � + f ! / .�� <br />� � � � ,�,,,' i �` CONTACT EMAIL• ' � .�. � � � �� � <br />AGREEMENT T hereby certriy that f have�read and examinetl this applrcahon and know the same fo be true and carrect. A!! provisrorts oflaws an[! ordinances goveming this <br />� ype af work wi(! pe complefed whefher specrfied herain or not The granting of a pennit doas nn! psesume to grve authqrrty �p Mdlate ar cancel the provisions of any other sta;e or <br />locaf taw regLlating construction or the pefionna�ce of construction. Thaf I am authorized Dy the owner ot this properry fo peAvftn ttre ww7c for �.vhicb application is made and t <br />comp/y wrth the SEate Contractors Law v8.27 RCW and 29ff.2Q0 WAC. <br />City of Everett Off;cial Use Onl� <br />FEE <br />� <br />���?.� <br />PERMIT # <br />_ �_ �-�;` �.....d��.. ��—�� - ��� E l 1��5— DZC� <br />OwnerlAuthorizetl Agent Signature Date (Revised ro�t212o75) <br />