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<br /> LECTRICAL PERMIT APPLICATION
<br /> CITY OF EVERETT PERMIT SERVICES
<br /> 3200 CEDAR STREET, EVERETT, WA 98201
<br /> (P)425-257-8810 I FAX 425-257-8857 J (E) everetteps@everettwa.gov www.everettwa.gov/permits
<br /> PROJECT SITE INFORMATION •
<br /> PROJECT ADDRESS: OO' g
<br /> BUILDING AREA(if residential,new construction,remodel,or addition) SF
<br /> BUILDING TYPE: 0 SFR-DETACHED 0 SFR-ATTACHED 0 DUPLEX 0 MULTI-FAMILY-#OF UNITS: 0 COMMERCIAL
<br /> USE OF BUILDING:
<br /> ELECTRICAL APPLICATION INFORMATION
<br /> CONTRACT PRICE OF WORK:$ tD%
<br /> NUMBER OF DEVICES(if low voltage):
<br /> FIRE ALARM? 0 YES 0 NO
<br /> ASSOCIATED BUILDING PERMIT#(if applicable):
<br /> DESCRIPTION OF WORK: ;A'1 !P k &• 1\
<br /> .effr s \
<br /> CONTACT'INFORMATION
<br /> OWNER NAME: ptt TENANT NAME(If Commercial):
<br /> OWNER MAILING ADDRESS: STREET ,0^)co' i'\
<br /> ! CITY ��1` 'V 1 STATE ZIP
<br /> I/
<br /> OWNER PHONE: 2 rp�- a +ems 7 OWNER EMAIL: M}��+b I �, "cam��e_
<br /> •
<br /> CONTRACTOR NAME:
<br /> CONTRACTOR ADDRESS: STREET
<br /> CITY STATE ZIP
<br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: .
<br /> CONTRACTOR LIC.#(REQUIRED): CITY OF EVERETT BUSINESS LIC.#(REQUIRED):
<br /> ...r�.�..,.r,c.,.,,.,......��,...u.,,�..,:.:,,,..,.,,�......�.._,..,�..,.,.._.......................,,,....:m_.,,,..fi_..,.,...�..,v,.::z�._�,....,...v:..z:u�..,,,y,...:W.w:,.-.,..-. -�:_...�...ra,,�4�,,._...,,..:,.,..M..,...��v.__.s...�_.�.....,....A,,.,...:,<.,b�-....._r_r�_.,_.....
<br /> PRIMARY CONTACT: QWNER 0 CONTRACTOR 0 OTHER(Please Specify)
<br /> CONTACT NAME: ` CONTACT PHONE:
<br /> CONTACT EMAIL: 14 p..5-0
<br /> � c„)?9� ye,
<br /> AGREEMENT:T hereby certify that I have read and examined this application and know the same to be true and corn t. All provisionstias and ordinances governing this
<br /> type of work will be completed whether specified herein or not. The granting of a permit does not presume to give authority to violate or cancel the provisions of any other state or
<br /> local law regulating construction or the performance of construction. That I am authorized by the owner of this property to perform the work for which application is made and 1
<br /> comply with the State Contractors Law 18.27 RCW and 296.200 WAC.
<br /> City of Everett Official Use Only
<br /> FEE
<br /> 41a,bC2,
<br /> / PERMIT#
<br /> , 18 E l 01.--11,
<br /> Owner/Authorizy Agent Signature Date (Revised 10/12/2015)
<br />
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