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ELECTRICAL PERMIT APPLICATION
<br /> CITY OF EVERETT PERMIT SERVICES
<br /> 3200 CEDAR STREET, EVERETT, WA 98201
<br /> (P)425-257-8810 � FAX 425-257-8857 � (E) everetteps@everettwa.gov� www.everettwa.gov/permits
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<br /> PROJECT ADDRESS: Cj CT�. � �.- �-�� ( I J� v
<br /> BUILDING AREA(if residential, new construction, remodel, or addition) '760 SF
<br /> BUILDWG TYPE: ❑SFR-DETACHED ❑SFR-ATTACHED ❑ DUPLEX MULTI-FAMILY-#OF UNITS: t ❑ COMMERCIAL
<br /> USE OF BUILDING: �
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<br /> � ,� ���,,f P�x�� � ;��� ��: , � + ��LECT�IGAL��APPLI,CATIOM INF.�dRM�AT�ION �y,��� ��� .,; � �,t , ,��
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<br /> CONTRACT PRICE OF WORK: $ �$(�
<br /> NUMBER OF DEVICES (if low voltage): 1
<br /> FIRE ALARM? ❑YES O
<br /> ASSOCIATED BUILDING PERMIT#(if applicable):
<br /> DESCRIPTION OF WORK: �s � L, � � � j L`
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<br /> OWNER NAME: �y.b..— 4 � \i�5 TENANT NAME(If Commercial)c (5/�i� � Vi4C� 1�
<br /> OWNER MAILING ADDRESS: sTReeT � �` (� P�1
<br /> CITY �V� STATE �� ZIP
<br /> OWNER PHONE: rj�- (7 � OWNER EMAIL:
<br /> CONTRACTOR NAME: L.L L�Lf Ll
<br /> CONTRACTOR ADDRESS: s-rRee-r '�(' �L� J� G L'I 1
<br /> , � � CITY .�G � � STATE ZIP �
<br /> CONTRACTOR PHONE: 36(� ��6" �I� CONTRACTOR EMAIL: �j� J� �
<br /> CONTRACTOR LIC.#(REQUIRED): �/�- �y (��- CITY OF EVERETT BUSWESS LIC.#(REQUIRED): (�
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<br /> PRIMARY CONTACT: ❑OWNER NTRACTOR ❑OTHER(Please Specify)
<br /> CONTACT NAME: CONTACT PHONE: J�� `��.�. _7 6
<br /> �L�,� � CONTACT EMAIL: ��1`C ��i �J�--.L^ , r
<br /> AGREEMENT.�1 hereby certify that l 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 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 aut6orized by the owner of this property to pertorm the work for which application is made and I
<br /> comply with the State Contractors Law 18.27 RCW and 296.200 WqC.
<br /> City of Everett Official Use Only
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<br /> PERMIT#
<br /> .,-' ''� ,� E �c�
<br /> � �7 �, -- Z� �
<br /> O r/Authorized Agent Signature Date (Revised 9/23/2016)
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