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<br /> ELECTRlCAL PERMIT APPLICATION
<br /> GITY OF EVERETT PERMIT SERVICES
<br /> 3200 CEDAR STREET, EVERETT,WA 98201
<br /> (P}425-257-8810 �'FAX 425-257-8857 � (Ej everetfeps@everetfwa.gov� www.everettwa,govlpermits
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<br /> PROJECT ADORESS„��:I I ,��,�� �, ;
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<br /> �UlLDING-AREA(if resldentlal,new construction,remo8e(,or��t�c��� S�
<br /> �fUILDiNG TYPE: ;�FR-DETACHED ❑SFR-ATTACHED ❑DUPLEX ❑MULTI-FAMILY-#OF UN�7`�: ❑COMMERC(AL
<br /> USE OF BU(LDING:
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<br /> CONTRACT.PRtCE OF WORK; $ � - -
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<br /> NUMBER QF DEVICES if low vol�� �q `
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<br /> ASSOCIATED$UIL�ING,PERMlT# Ef a -licabl�r:;
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<br /> f?Y�tN�R f+lAME, �, TE�1 "�NAME 1!`Commerctat: :
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<br /> .� . . Cl:1"EF . . . ..�. .... ... STATE��'V �� �L71 O ....
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<br /> OWNER PHONEt OWNER EMAIL: '
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<br /> G�[si'f'E`t/�C'f'CIR NAME: '
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<br /> �C)NTRACTOR ADDRESS: STREET � , � �� : _ . _
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<br /> ,. e STATE ZIP
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<br /> CI'fY C#F����7`T'BUStN���.LIGt�R�QLti�t7: .:.;:. .,.....m.
<br /> j'RlMARY CONTACT: O OWNER CON7RACTOR �C OTHER(Please Specify)
<br /> CONTACT NAME:
<br /> Ci�tTACT PHONE:
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<br /> AGREEMENT,t hereby certify that. hsva read and examfned fhls app/icet/on and know the same to tre hve end Correci. A!!provisions of Iewe and ordinences goveming this[ype
<br /> 01 work wll!be completed whelher specltled herein or noG The granOng o/a permlf does nol presume to g/ve eufhodfy lo vfolate orcansel the provlslons of any other sfa(e or
<br /> local!aw ragulating consUucfion or fhe pertormance of construcUon. That!am aufhorized 6y the owner of fhls property to pertoim the work for whkh appllcation Is made and I
<br /> comply wifh the State Conlractors Law 18.27 RCW and 29fi.2D0 WAC.
<br /> Clly of Evereft Olflcla!Use Only
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<br /> v- �� ` - PERMIT#
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<br /> thqxtzad Agent Stgnature - �� v � ��
<br /> _ Date
<br /> (Revlsed 9/23/Y016J
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