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11/29/2016 TUE 12: 03 FAX 425 252 1666 CM Heating 0003/003 <br /> ELECTRICAL PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> q�vlz (P) 425-257-8810 FAX 425-257-8857 1 (E) everettepsgeverettwa.gov I www.everettwEi.gov/permits <br /> �v1" ' ',.4�' t„+,J•�+ ` ;�rtih?t: ti 1,I'r. ' {� <br /> PROJECT ADDRESS; <br /> BUILDING AREA(If resldentlal, new construction, remodel, or addition) SF <br /> BUILDING TYPE; FR-DETACHED 0 SFR-ATTACHED ❑ DUPLEX ❑ MULTI-FAMILY-#OF UNITS: ❑ COMMERCIAL <br /> USE OF BUILDING: <br /> AM> <br /> CONTRACT PRICE OF WORK: $ <br /> NUMBER OF DEVICES if low voltage): <br /> FIRE ALARM? ❑ YES ❑ NO <br /> ASSOCIATED BUILDING PERMIT# If applicable): <br /> DESCRIPTION OF WORK: <br /> LL.V Ceu <br /> 4 ' i• .I. .q I' <br /> OWNER NAME: TENANT NAME If Commercial); <br /> OWNER MAILINQ ADDRESS; STREET "p//�� (� 2 <br /> C ITY STATE ZIP <br /> OWNER PHONE: �-2� 2 U — OWNER EMAIL; <br /> CONTRACTOR NAME; <br /> CONTRACTOR ADDRESS; STREET <br /> CITY STALE <br /> ZIP <br /> CONTRACTOR PHONE; Q� CONTRACTOR EMAIL; (l�) <br /> CONTRACTOR LIC.#REOIJIREp : CITY OF EVERETT BUSINESS LIC.#REQUIRED : Q <br /> PRIMARY CONTACT; 11 OWNER CONTRACTOR Q OTHER(Please Speclfy) <br /> CONTACT NAME; CONTACT PHONE: <br /> CONTACT EMAIL; <br /> AGREEMENT'Thereby certify that 1 havo read and examined this Application and know the same to be true and oorrect. All prov/slops of sews and ord rcos governing this <br /> type of work will be Completed whetherspecllled herein ar not. rhe granting(Ila permit does not prosuma to give authority to violate or cancel the prcvlslons of any othar state or <br /> local law regulating construction Or the performance of construction• That Ism authorized by the owner of this properly to perform the work for which application is made and I <br /> comply with(he Stats Contractors Law 10.27 RCW and 296.200 WAC. <br /> City of Everott Oficial(iso Only <br /> FE <br /> PERMIT# <br /> E `((A ( -- MLt <br /> Owner/Authorlaad Agaht Signature Date (Revised 1011212015) <br />