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06/21/2016 TUE 12: 57 FAX 425 252 1666 CM Heating U002/003
<br /> &ECTRICAL PERMIT APPLICATION
<br /> CITY OF EVERETT PERMIT SERVICES
<br /> 4L 3200 CEDAR STREET, EVERETT, WA 98201
<br /> (P) 425-257-8810 FAX 425-257.8857 1 (E) everetteps@everettwa.gov www.everettwa.gov/permits
<br /> '77,
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<br /> ,E r• 1tl lr.'.f°'�i'u, 1 r, '
<br /> PROJECT ADDRESS:
<br /> BUILDING AREA(If rosldentlal, new constructlon, remodel,or addition) SF
<br /> BUILDING TYPE: SFR-DETACHEp FR-ATTACHED la DUPLI=X ❑ MULTI-FAMILY-#OF UNITS; El COMMERCIAL
<br /> USE OF BUILDING:
<br /> 7s .
<br /> , , r P •�1l V
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<br /> ,a d . � r.,•. 4,n, .t }, •.�. ir...,l)'•v.lS d.t,�:.�it. ;9
<br /> CONTRACT PRICE OF WORK: $
<br /> NUMBER OF DEVICES If low volts o
<br /> FIRE ALARM? ❑ YES Q NO
<br /> ASSOCIATED BUILDING PERMIT# If applicable):
<br /> DESCRIPTION OF WORK:
<br /> C-Ale C
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<br /> OWNER NAME: TENANT NAME It Commercial);
<br /> OWNER MAILING ADDRESS: STREET
<br /> CITY
<br /> STATE ZIP
<br /> OWNER PHONE: OWNER EMAIL.:
<br /> CONTRACTOR NAME:
<br /> CONTRACTOR ADDRESS; 9TH� T
<br /> C rry STATE ZIP
<br /> CQNTRACTOR PHONE;L�g OZ> CONTRACTOR EMAIL;
<br /> CONTRACTOR LIC.#REQUIReo ; CITY OF EVERETT SUSINE88 LIC.#R�QuIREo: Q
<br /> PRIMARY CONTACT. Ca OWNER CONTRACTOR [7 OTHER(Please Spaclfy)
<br /> CONTACT NAME:
<br /> (� CONTACT PHONE: —�
<br /> (d(� CONTACT EMAIL:
<br /> AGREEMENT:Thereby cortlfy that I have read and examined this application and know the same to be true and correct, AN provlslona of laws end ora races governing this
<br /> type of work will be completed whether specllfed herein or not. The granting of a permit dada not presume to give authority to violate or canoel the provlslcns of any othor state or
<br /> loeal law r60uOting constructlon or the performance of conslructlon. That I am authorized by the owner of thls property to perform the work for welch appllcatlon is made and I
<br /> comply with rhe State Contractors Law 1 a.27 RCW and 205.200 WAC,
<br /> City of Everett Offlclal Use Only
<br /> FEE
<br /> n PERMIT#
<br /> L4 (COwner/Authorized Agent Signature Date (Revised 1011Q/z015)
<br />
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