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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: �Z I S�S"� ,5�� ��lJ �7�'/ �/U�- ��2.O�
<br /> BUILDING AREA(if residential,new construction, remodel,or addition) SF
<br /> BUILDING TYPE: ❑SFR-DETACHED �p 5FR-ATTACHED ❑ DUPLEX ❑ MULTI-FAMILY-#OF UNITS: ❑COMMERCIAL
<br /> USE OF BUILDING: �-{� �j (/%�
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<br /> CONTRACT PRICE OF WORK: $ �,Q(�
<br /> NUMBER OF DEVICES(if low voltage):
<br /> FIRE ALARM? ❑YES �NO
<br /> ASSOCIATED BUILDING PERMIT#(if applicable):
<br /> DESCRIPTION OF WORK: �( � (� GI�(/l�,�T � � � � IS �I,V1U� �I/l'I� �'
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<br /> OWNER NAME: T�� TENANT NAME(If Commercial):
<br /> OWNER MAILING ADDRESS: srReeT VI�I � S T �� �
<br /> � CITY L����l/Y v 1� STATE W� ZI�(OV F—V�
<br /> OWNERPHONE: �{Z�' ��"�I' �IZ�j OWNEREMAIL: ��i9'
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<br /> CONTRACTORNAME: I� �lv�S'e �I��vl C�� ��/�I�/GPS� �{�IG-,
<br /> CONTRACTORADDRESS: STREET ��30 ���� �/�- S�
<br /> CITY �f� U i�(/�V^Y{� STATE �/ ' ZIP ���✓tJ �
<br /> CONTRACTOR PHONE;^�2'�j ��OD 32l�j CONTRACTOR EMAIL: 1�(y� /N1O(J�,
<br /> CONTRACTOR LIC.#(REQUIRED):�/V /�^ -�j 2 GZ C77 CITY OF EVERETT BUSINESS LIC.#(REQUIRED): Q���C?�
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<br /> PRIMARY CONTACT: ❑OWNER ❑CONTRACTOR OTHER Please S eci
<br /> CONTACT NAME: �1i'�/ ,// CONTACT PHONE: !�Z�j ��U �j Z O�'j
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<br /> � CONTACT EMAIL:
<br /> AGREEMENT:!hereby certify that 1 have read and examined this application and know the same to be t e and correct. All provisions of laws and ordinances goveming fhis fype
<br /> of work will be completed whether specified herein or not The granting of a permit does not presume to give authorify to violate or cancel the provisions of any other state or
<br /> local law regulating construction or fhe performance of construction. That I am authorized by the owner of this property to perform the work for which application is made and l
<br /> comply with the State Contractors Law 18.27 RCW and 296.200 WAC.
<br /> City of Evereff Official Use Only
<br /> PERMIT#
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<br /> Owner/Au orized Agent Signa re Date (Revised 9/23/2016)
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