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� <br /> � <br /> ELECTRICAL PERIIAIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> (R)425-257-8810 � FAX 425-257-gg57 � (E)everetteps(d everettwa.gov( www.everethara.gov/permits <br /> �. <br /> , . : .�!R.0,1L°��"!"�1��N�'���� .....�',' <br /> PROJECT ADDRESS: � �,? � <br /> BUILDING ARFA(if residential,new construction,remodel,or addl6onj gF <br /> BUILDING TYpE: ❑SFR-DETACHED O SFR-ATTACHED ❑DUPLEX ❑MULTI-FAMILY-#OF UNITS: COMMERCIAL <br /> USE OF BUILDING: , ' <br /> c <br /> !LE",+�T��AL A�'PLIC�IIfi10N iN��A�TlOt�` <br /> CONTRACT PRICE OF WORK:S � � � �' <br /> NUMBER OF DEYICES if low volta e: <br /> FIRE ALARM? O YES Cl NO <br /> ASSOCiATED BUILDING PERMIT# if a licable: <br /> DESCRIPTION OF WORK: � � * , � � � <br /> ca�rracr tNN=o�MA�MqM <br /> OWNER NAME: TENANT NAME H Commerclal: �� R, <br /> OWNER MAILING ADDRESS: srneEr <br /> cm <br /> STATE Lp <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: ' � • <br /> � �r ; � c> <br /> CONTRACTOR ADDRESS: srne� Z <br /> crrv <br /> � <br /> srn� �, ' � <br /> CONTRACTOR PHONE: d CONTRACTOR EMAIL: ' ' <br /> � . . > ,^ �c.c'_ � : <br /> CONTRACTOR LIC.#(REQUIRED): p CITY OF EVEREiT BUSINESS UC.#(REQUIRED): <br /> PRIMARY CONTACT: ❑OWNER ONTRACTOR �OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: <br /> � S'��c�� <br /> �,� CONT'ACT EMAIL: �,..,�� , � <br /> AGRFEMENT.•1 hereb oe ' '� ` C--�% <br /> Y rfKy that I heve read and examined thls app/icatfon and know ihe same to be trve and conert sUl piovisla�s of laws end ortiirrenc�e.s <br /> of work will be comp/eted whether sPeci/fed herain or not. The 8°i��9�++s tYPB <br /> local law regulating conshuctia�or dre perfomearrce of aonst�ion. 7tia�em euflroviied by�owner���Nty�via+ate ar cancet the piovisions oI any oHrer state a <br /> ��Ah'w�me Slats Conhactors Law 1 B.27 RCW and 296.200 WAC. ro��y ��0�m�'�����^��n Is made ancl I <br /> Ciry of Eve�eft Oflfcia/Use Only <br /> ��? PERM(T# <br /> .__ ____ 2 � E �I 02-� <br /> 1 � <br /> r/AtRho AgeM Sfgnatu►e te (������6� <br />