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ELECTRICAL PERMIT APPLICATION
<br /> ' ►i l: CITY OF EVERETT PERMIT SERVICES
<br /> ��� 3200 CEDAR STREET,EVERETT,WA 98201
<br /> (P)425-257-8810 1 FAX 425-257-8857 ((E)everetteps@evereftwa.gov evereftwa.gov I www.everettwa govlpermits
<br /> .,,,,,,,, ,,,,,i,,,,,-;, ,,,,.. ,...,,,.4,,,,.�,.+. W a..x '. '�.a,.,c >rrm,. .ica,, .J � „, .. ,. ,fit _e ., .. ., .�,4. .... ,.
<br /> PROJECT ADDRESS: 5O ) q
<br /> BUILDING AREA(if residential,new construction,remodel,or addition) SF
<br /> BUILDING TYPE: L JSFR-DETACHED_ 0 SFR-ATTACHED 0 DUPLEX 0 MULTI-FAMILY-#OF UNITS: 0 COMMERCIAL
<br /> USE OF BUILDING:
<br /> `' aV r `gra:`c x r :r �, ,u�
<br /> . .. ., a.. , .... .,. ,... ,.fi,,,,,,,,:,,2,-,,;4„--,3}., L,. -i'.. ,... ,.. f -...0 _. ..
<br /> CONTRACT PRICE OF WORK:$ r9, , • 0 0
<br /> NUMBER OF DEVICES(if tow voltage):
<br /> FIRE ALARM? CI YE$• 0 NO
<br /> ASSOCIATED BUILDING PERMIT'##(if applicable): J
<br /> DESCRIPTION OF WORK: ro 1--61"12.,-* �G Y'- ' .. nn2`" z / C el
<br /> OWNER NAME J)f`I t' L a TENANT NAME(if.,
<br /> Commercial):
<br /> OWNER MAILING ADDRESS: sTR Er `4 1
<br /> ti X3
<br /> crTY �✓tker /
<br /> STATE 4 ZIP Li
<br /> OWNER PHONE: 7 t Pt7% OWNER EMAIL
<br /> CONTRACTOR NAME: f/TY- i--r?"7.r1 1-lea-/-1,-.11 y i'" -t-
<br /> CONTRACTOR ADDRESS: STREET `-'T—1 j 'tel
<br /> CITYr y V i 1,14- STATE airzip e dS v
<br /> CONTRACTOR PHONE: -3-3S .74./4-01-61 CONTRACTOR EMAIL: e)v nil6)/2949C0$44-. "lel'.
<br /> CONTRACTOR LIC REQUIRED) h0 r ,5h q¶ CITY OF EVERETT BUSINESS LIC EQUIRED): q„ '
<br /> PRIMARY CONTACT: 0 OWNER r,! ONTRACTOR Cl OTHER(Please Specify)
<br /> CONTACT N ., EE:' 1 CONTACT PHONE: 1.4-3._5- "..�" C`
<br /> CONTACT EMAIL: ►t t1
<br /> / kC 440
<br /> AGREEMENT:.t hereby certify that i have read and examined this application and know the same to be true:and correct. All provisions of laws and ordinances governing this,type
<br /> of work will be completed whether specified herein ornat. The granting of a:permit does not presume to give authority to violate or cancel the pmvisions of any other state or
<br /> local law regulating construction or the performance of construction. That lam authorized by the owner of this property to perforin the work for which application is made and I
<br /> comply with the State Contractors Law 1837 RCW and 296,200 WAC.
<br /> City of Everett Official Use Only
<br /> \` PERMIT#
<br /> 1/1 62 i il V E1. 61 I
<br /> Owner/Authorized ent Signature Date (Revised 9/23/2016)
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