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ELECTRiCAL PERMIT APPLICATION <br /> CITY OF EV�RE77 PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT,WA 98201 <br /> (P)426-257-881 p ( FAX 425-257-8857 f (E)everetteps@evere#twa.gov� www.everetiwa.gov/permits <br /> ;::;.:::::::::.;;:.;::::::::::.::::-.::::«:..:::,,::;:::;::;:;::.:.:;::.::.::::::.::::::::..,::-::.:: <br /> :r;s:':<::P:R'OJ <br /> E T: <br /> C SITE'INFORMAT.�ON ,:::::;;,:'.',; <br /> . . <:.:.::.:_:..::.::.::...::::::::::c:::,:;.::::.:..:::r::: <br /> .. ........... . .. .:.__... :_. ....... �:.::::.:.::.: ..;:.::.;:-,::::::..::;::;:::::::.::::. <br /> Pf20JECTAbt3RESS:�j,��� '���(�j l <br /> BUILDING ARFA(if residential,new canstruction,remodel,or addition) l��-f-� SF <br /> BUILDING TYP�;�FR-DETACHED ❑SFft-ATTACHED ❑ DUPL�X ❑MUL7f-FAMILY-#OF UNITS: �COMMERCIAL <br /> USE OF BUILDING: �� � � ;^b <br /> .::.::::::::::.::::::::.::::>:.::,:::::.;:-::....................._.... <br /> ;:<;'::;:::ELECTRICAL:�P ,; <br /> P <br /> .L1CAT O :> <br /> 1 N.INFORM . . <br /> AT10N;:;'.::i�i.>;=;;>;:;:<;<:;;::`::;.:;;;;':;;::i::::::::c:::::::::::::::::.';::i:::::::;;'::::;,.,'::;::::;:;:;::: <br /> ,-: <br /> . .:..: :. .: .::.... ...:...:::::..;. <br /> G�NTRACT PR10E OF WORK: $ ��i��;jt�;. <br /> NUMBER OF DEVICES(if low vof#age); <br /> fIRE ALARM? ❑YES CI NO <br /> ASSOCIATED BWLDWG PERMIT# if a licable : <br /> DESCRIPTION tiF WORK: � t t�p 41 G � :4i� �;�(�.�' ` �� �} �{;�,�� , �, tl -. <br /> ...J <br /> °:;;::::::CONTA T:: <br /> G fNFORM <br /> ATION::::.:.:::.:::>;;:.:.;;.:>:r::;;::::::::::�:.::..:>;::;::;::::.;;:::::.::,;:;:;-;.:::;:::::>::::::::<:;-;::;::;:::::;::;:;:;.,.. <br /> . ..... ...:.. . ...:. .............................. :. .. ..... ...::.......:........;.::..::::::::::::::.;:.:::::.,;..;:.:......,..;.:::-,.:.:.,.::....:..:,:.::.:-,;:-...:,: <br /> _......... <br /> OWNER NAM�: (1,� �;b� �r ;1 . :r TENANT NAME(!f Commercian: <br /> OWNER MAILING ADDRESS: sr�Er � �-{�1.� j� ' �^, p�. � . <br /> CtTY � �/�, STATE 1i� ZIP �( r� '] <br /> OWN�R PHONE: �' ���j'���— �j�}S(� OWNER EMAIL: <br /> CONTRACTOR NAMB; ��t <br /> CONTRAC70R ADDRESS: � STREET�j (1 .q.�.. ����(i <br /> �� � � STATE �P a . o <br /> CONTRACTO}2 PHONE: 6� `�}(}'� C,`� CONTRACTOR EMAIL: .��' n,{�G'� i � �-��,�� � '�.�✓E <br /> CONTRACTQR LIC.#(REQU#RED): �I-� 1 S� � 8�Si C[7'Y OF EVERETT S SlNESS LIC.#REQUIRED): � Gj�,p. \ <br /> PRIMARY C4NTACT: ❑OWNEft CONTRACTQR ❑OTHER(Please Specify) <br /> CON'CACT AfAME: CONTACT PFIONE: ���'_ �F,{�-�_(„tS,^5--� <br /> � �,I'�� ��9� (��..t��� con�-�Acr��w�: � �� � ��>G,C�t P ;,-�-� i�c, : C t�, <br /> AGREEMENT.•i hereby certify that 1 have read and examined fhrs application and know#he same fo be true and correci�AH prnvisions oflai�rs�and ordinances govemfng this type <br /> of work wi!!be completed whether speci6ed herein or not. The granting of a parmif does not presume fo give authority to violate or cance!fhe provisions of any other state or <br /> loca!law regulating consfrucfion ar fhe performanae of construction. That 1 am authorrzed by fhe owner of ihis property io perform the work for which appllcafion is made and 1 <br /> comply with the State Canfractors Law 18.27 RCW and 296.200 WAC. <br /> City of EverBtt O�cia/Use Only <br /> PERM(T# <br /> .,� �;r �� � - ��;�f �� �.� � E ��3 - o�-3 <br /> OvmerlAuthorized Agent Signature � Date � (Revised 9/23/2016) <br />