Laserfiche WebLink
� • <br /> ELECTRICAL PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> (P)425-257-BB10 � FAX 425-257-8857 � (E)everetteps@everettwa.gov � www.everettwa.gov/permits <br /> PROJECT S1TE;IIsIFCfi�MAT1ON <br /> PROJEGT ADORESS: �,�,� � "�" <br /> BUILbING AREA(if resldentlal,new constructfon, remodel, a�Jdttlon} SF <br /> BUILDING TYPE: SFR-DETACHED ❑ SFR-ATTACHED ❑DUPLEX ❑ MULTI-FAMILY-#OF UNITS: � COMMERCIAL <br /> USE OF BUILDING: <br /> ELECTRICAC`APPL1CATiClN 11�I�ORMA'�'ION <br /> CONTRACT PRICE OF WORK: $ (� ,� <br /> NUMBER OF DEVICES if fow volta e): <br /> FIRE ALARM? ❑YES ❑ NO <br /> ASSOCIATED BUILDING PERMIT# if appiicable); <br /> o�sc���rt�� c��.�c�►��c; _ � _ Y"`t�"1.C�,�.s�.�. ''�• �„ <br /> Ct�t+�;�'ACT.IN�+�'�RM'A`i'Mi�N <br /> 04'VMER NAME; TENANT NAME If Conrm�rCla1 ; <br /> OWNER MAILINC�ADDRESS: sTReer �{�„rn,,,�,,,j� <br /> �R\' STATE 1 r ZIP <br /> OWNER PHONE: �Z 'r'.�' 2—Jg OWNER EMAIL: <br /> CONTRACTOR NAME: � <br /> CONTRACTOR ADDRESS: srrtEET � � ��}� <br /> ciTv sTntE �- zia �(� <br /> 'CCJIVTRAf:T4R RHClPJE`. �{ CONTRACTdR EiV1A1L.: r `'�,�� <br /> � n_ � _ . ....— — — <br /> ) �T(��'������,���. CITY ERETT B <br /> (REQUIRED:� OF EV <br /> ,� �..�., <br /> _ <br /> USINESS LIC,#(RE�lUlR�Oj. <br /> PRIMARY CONTACT: ❑OWNER CONTRACTOR ❑OTHER(Please 5pecify) <br /> CONTACT NAME: COt�TACT PHONE; �� ��Gi D� <br /> � ��C.. CONTACT EMAIL C�P.I� , l ��Q'�l •COI� <br /> AGREEMENT:i hereby certily thaf F have read and exeminad fhis applrcetion and know the same fo be true end correct. AN provlsions of laws and ordinances goveming thrs type <br /> of work wll!be complafed whether speclfied herein or nof. The granling of e permlt does not presume to glve euthodty to vlolate or cancel the provlslons of any ofher sfate or <br /> locat!aw regulattng construclion or fhe per/ormance o1 construction. Thaf 1 am authorized by the owner o!Ihls pmperty to perform the wak for whlch appllcatfon ls made and d <br /> comply with the 5fele Contractors Law f8,27 RCW and 296.200 WAC. <br /> City of Everett O/flcla!Use Onfy <br /> PERMIT# <br /> � .�..��_� �a.�..� � _l�� 3 ��� E �I �D�� <br /> OwnerlAutktiacixed Agent Signat�ur������� Date (Revlsed 9/23/2076J <br />