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ELECTRICAL PERMIT APPLICA
<br /> ���IG[NAL
<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 /> we�.�_,fa �s��a.�; ,�..� ,. � $ � w����,G��r _ � �����'F��6�Q ' r,'a���,�+� r��� �5+��� � �a�F " v
<br /> .__r, ��� �� ;�: � i ui. � �,�f.�. �,�t� ��� e�,n< r
<br /> PROJECT ADDRESS:
<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:
<br /> �k�hh�P�7Mryi�p. " ..:_,;���i�N'�d��i�*,�'�"'�'�i t' �J�E. '�'" � e p'N" a� ro WI"i�i d,�um �Mi ii i�w.m! � x ,ut r ��� w� ..�� G�9�� ��u�#�' �' i s'Yp� �
<br /> x o �
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<br /> �'r Itr,.�ib&�"�Ev*r�d�ll °� �'�.:.:",�a�t""-�.G ;�%f�. �J d 2'i'�i:.�Ei�E"� °�sab a�,.: ,�� .�,�..'Oo-��i . � �;_nw a5�k�� R�,'$�;� a i�M1r,',��,�# ..1t'..�t s:; n45��;"�.����1�'a.��fi
<br /> CONTRACT PRICE OF WORK:$ � � �
<br /> NUMBER OF DEVICES if low volta e :
<br /> FIRE ALARM? ❑YES ❑NO
<br /> ASSOCIATED BUILDING PERMIT# if a licable :
<br /> DESCRIPTION OF WORK: 1 �_ f`� [Ut.�t/L_ �-��"1��C, �7/l� C.SL_
<br /> — xd � � � ��,� � k ,��'1»�� �?,i.� as � � '�, �� ,�s a 3 . 1�"��E"�'r� '"b�,'�
<br /> £ �� °" _�.��� �"^..:����..� '�h'�����I�ACT 1NFOI��A'i'�dN�� � �s� '�� _ '���°.�:��� ,,,��.
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<br /> OWNER NAME: �JLV N� �f'i� � � S �/�,
<br /> OWNER MAILING ADDRESS: sTaeeT � �p
<br /> CITY STATE ✓ y ZIP
<br /> OWNER PHONE: 2 � � "I OWNER EMAIL: l�l, � �
<br /> CONTRACTOR NAME: ��-Q�i
<br /> CONTRACTOR ADDRESS: sTaeeT 1 � C/G'L�� �V"
<br /> CIN ' STATE ZIP /
<br /> CONTRACTOR PHONE: �� CONTRACTOR EMAIL: � �
<br /> CONTRACTOR LIC.#(REQUIRED): �{�'r � �� Y`-�� CITY OF EVERETT BUSINESS LIC.#(REQUIRED):� �
<br /> _� . .F_. . � .�� ��.���_ , ..._� w .._,
<br /> PRIMARY CONTACT: ❑OWNER NTRACTOR ❑OTHER(Please Specify)
<br /> CO TACT�NA,A(IE: � CONTACT PHONE: �� `� . "'� l
<br /> �V Cn-�^^' C� "`� t CONTACT EMAIL:
<br /> AGREEMENT.•T hereby certify that I have read and examined this applicafion and know the same to be true and correct. A!1 provisions of/aws and ordinances governing this
<br /> rype of work will be completed whethei spec�ed herein or not. The granting of a permit does not presume to give authoriry to violate or cancel the provisions of any other state or
<br /> local law regulating construction or the perfoimance of consfruction. Thai I am authorized by the owner of this property to perform the work for which application is made and l
<br /> comply with the State Contractors Law 18.27 RCW and 296.200 W,4C.
<br /> City of Everett OSicia/Use Only
<br /> FEE
<br /> �: t�-c,2 .- 62
<br /> PERMIT
<br /> C 2� ��� �'�� E �
<br /> Owner/ zed Agent Signature Date (Revised 10/12/2015)
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