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�ECTRICAL PERMIT � LICATION
<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: ` , (,� G��-- ��
<br /> BUILDING AREA(if residential, new construction, remodel,or addition) SF
<br /> BUILDING TYPE: FR-DETACHED ❑ SFR-ATTACHED ❑ DUPLEX ❑ MULTI-FAMILY-#OF UNITS: ❑ COMMERCIAL
<br /> USE OF BUILDING:
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<br /> CONTRACT PRICE OF WORK: $ ��Z�
<br /> NUMBER OF DEVICES if low volta e :
<br /> FIRE ALARM? ❑YES ❑ NO
<br /> ASSOCIATED BUILDING PERMIT# if a licable :
<br /> DESCRIPTION OF WORK: j�� " �`�'� ' � � � lJS c"'�, � i,l-�
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<br /> OWNER NAME: , �'�� ��{2- TENANT NAME(If Commercial :
<br /> OWNER MAILING ADDRESS: sTREET ` �U 1��.%�
<br /> CITY .���� STATE �—`� ZIP �� �
<br /> OWNER PHONE: � � �Q'�[rj ' ��-=���? OWNER EMAIL:
<br /> ��CTOR NAME: t1V1. ��ft.. � �VV�.....,.... _���.,. .. . „��,�„ _� ,,,,,, w, . _
<br /> CONTRA ' Ll,� G�`Y\S
<br /> CONTRACTORADDRESS: srReer (� ��t;.. �$
<br /> � CITY �� 5��.�,� STATE � G� ZIP ����Q
<br /> CONTRACTOR PHONE: ;�CvO• Ei�S �CS` !� CONTRACTOR EMAIL:
<br /> CONTRACTOR LIC.#(REG2UIRED): `t"'Ta������� CITY OF EVERETT BUSINESS LIC.#(REQUIRED):�J���c.�
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<br /> PRIMARY CONTACT: ❑OWNER �CONTRACTOR ❑OTHER(Please Specify)
<br /> CONTACT NAME: CONTACT PHONE: �'
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<br /> �1�.GZ- ���t_,("�1 CONTACT EMAIL: y� �j �GT.,,'�/lr '�j f'�....� . ���1"„�
<br /> AGREEMENT:l hereby certify that I have read and examined this application and know the same to be true and cor ect. All pro 'ions of/aws 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 1 am autho�ized by the owner of this property fo perform the work for which application is made and l
<br /> comply with the State Contractors Law 18.27 RCW and 296.200 WAC.
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<br /> City of Everett Official Use Only
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<br /> 'f`,�'���� �� PERMIT#
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<br /> Owner/ horiz d Agent Signature Date (Revised 9/23/2016)
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