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� � <br /> ELECTRICAL PERMIT APPLlCAT�ON <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 <br /> P�t�JECT SIT�:INPORi�ATtON <br /> 'PROJECT ADDRESS: Q,, <br /> BUILDING AREA(if residential,new construction,remodel,or�dditlon) SF <br /> BUILDING TYPE: SFR-DETACHED ❑ SFR-ATTACHED ❑DUPLEX ❑MULTI-FAMILY-#OF UNITS: ❑ COMMERCIAL <br /> 'USE OF BUILDING: <br /> ELE�T�tICAL APP'N.I�/#Ttt3�N IN�C��MAT10N <br /> CQNTRACT PRICE OF WORK: $ (� ,E'`' <br /> NUMBER OF DEVtCES if low ualta � : <br /> FIRE ALARM? ❑YES ❑ NO <br /> A�SOClATED BUILDING PERMIT# if a iicable; <br /> DESCRIPTION OF WORK: � <br /> CONT�4CT [�+IF'£3RMJ�►7"1+�1N <br /> OWNER NAME: � TENANT NAME tf Commerclal a <br /> OWNER MAILING ADDRE5S: sTReer � <br /> cro sTn�E � ziP p <br /> OWNER PHONE �",�� > �.�t�, ^ ,,�,,,,,� OWNER EMAIL: <br /> CONTRACTOR NAME: t� <br /> CONTRACTORADDRESS; sTReeT � � ���� <br /> ciTr � sTnTe � zic� ��Zv� <br /> CONTRACTOR PHONE: � CONTRACTOR E1'w1AiL: � ,�}YYi <br /> CONTRACTOR UG.#$RF�C2UIRE��;��� ' � �,d� G1TY OF EVERETT BUSINESS LIC.#�R�G2UiR�t7�t <br /> PRIMARY CONTACT: ❑OWNER CONTRACTOR ❑�THER(Please SPecify} <br /> CONTACT NAME: 'CONTACT PHONE: � ��9 ���. <br /> i ��,/ `/� ' ; " <br /> ! C,7i�(C, CONTACT EMAIL: �: '� ��' ,GPj((Y� <br /> AGREEMENT:1 hereby certi(y(haf#have read and examined thfs application and know fhe same lo be t�ue and correct. Ail provisions ollaws and wdinanees goveming this type <br /> o!work will be completed whether specified hereln or not. The granftng ol a permif does nof presume to glve authori[y fo violafe or cancel fhe provislons of any other state or <br /> local(aw regulafing constructron or fhe performance o/consbuctron. Thaf!am aufhorized by the awner of(hfs propeNy to perlorm fhe work for whlch appUcation!s made and! <br /> comply wlfh the State Contracfors Law 18,27 RCW and 296.200 WAC. <br /> City of Everett Offlctal Use Oniy <br /> PERMIT# <br /> �i�k�. �CI...#�, , !O�r o.� 7 E ,���� �� <br /> .•__ . ,�-�-�----�--�_. _. _..._... . ._... <br /> t7wtterlAuthorized Agent Signature Date (Revised 9/23/2016) <br />