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<br /> ELECTRICAL PERMIT APPLICATION
<br /> CITY O� EVERETT PERMIT SERVICES
<br /> 3200 C�DAR STREET, EVERETT,WA 98201
<br /> (P)425-257-8810 ( FAX 425-257-$857 j (E)everetteps@everetfwa.gav � www.everettwa.gov/permits
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<br /> PROJECT ADbl2E3S: '� �� �.' i � I �� ; r' �✓ ����(/'.,
<br /> BUILDING AREA{if residential, new construction,remodel,ar addition) r�`"-��- SF
<br /> BUILDING TYPE; SFR-DETACWED ❑SFR-ATTACHED ❑DUPLEX ❑MULTI-FAMILY-#OF UNITS: ❑COMMERCIA�
<br /> USE OF BUILDING: �, `'4`�
<br /> - r=,, F^Y��-��' �-c,—'YG zvr�-$���'$ � ��J�j�,����`-,� u ����f-����.c�N '��� �,��r"'� 7'�''d'� �-�.
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<br /> CONTRACT PRICE OF WORK: $ �- "� ���,��/'
<br /> NUMBER OF DEVICES if lowvoltage):
<br /> FIRE ALARM7 0 YES ❑NO
<br /> ASSOCIATED BWLDING PERMIT#(if ap Eicable): �
<br /> DESCRIPT{ON OF WORK: j,,/'��. �..��� � �`:��� -�- v'Y �*� �'l�� i�.G������ �s f'�°."'.�, ,
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<br /> OWNER NAME; ';;/';,/,"� �f ' . �� 'j TENANT NAME(ff Commerclal): /1 ��
<br /> OWNER MAILING ADDRESS: srneer � ' ��` C'r�.%p
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<br /> OWNER PHONE: �:��i%�- `��L;=�j ,- 1_'C.i� 'r OWNER EMA{L: -`"�"�y���
<br /> CONTRACTOR NAME: 1�l �• u� � i'
<br /> CON7RACTOR ADDRESS: sTReer ''"� 7�� , �;. � " 1 %1`�,
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<br /> CON7F2ACT0(2 PHONE; '� ? % �� - �I 2%� CONTRACTOR EMAIL; ���' ! f a �'; '. � '��
<br /> CONTRACTOR LIC.#{RE4UIRED}: `��ti�.G��-�� �'�I�l� CITY O��VERETT BUSINESS LIC.#(REc�UIRED): `j� y'i��
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<br /> PRIMARY CONTACT: ❑OWNER II..CONTRACTOR L7 OTHER(Piease Specify)
<br /> C TACT NAME: CONTACT PHONE; "� ��J _� � �� _ < <�
<br /> ��,�'`��`�', i/ ��� ��`; CONTACT EMAtL: I t f I�-� � ��J� � ✓i . r
<br /> AGREEMENT.�1 hereby cert(fy.��t!have read and examined this epplication and know fhe same to be irue end correct. A!1 pfovislorts of Jaws and ordJnances governing !s type
<br /> of work will be completed whether speclfJed herein or noi. 7he grantin,q of a permil does not p�esume to gfve aufhori[y fo vrolate or cancef the provisions of any other`St3 e or
<br /> local!aw regulating consfructlon or ths par�ormance of construofion. That!am aufhorized by fhe owner of thfs prope�ty tn perform the work for which applicatrai is made and!
<br /> comply with Ihe Siate Contractors Law i8.27 RCW and 296200 WAC.
<br /> r� City of Everett Officia!Use Onty
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<br /> � V �•� �� � � PERMIT#
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<br /> Own uthorized Agent Sig�Sature Date (Revised 9/23/20 J6}
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