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ELECTRICAL PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERV(CES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> (P)425-257-8810 � FAX 425-257-8857 � (E)everetteps@everettwa.gov � www.everektwa.govlpermits <br /> PR4��lE�T SlTE 1NFi'lRM�4TIc1N <br /> PROJECT ADDRESS: L��, � � �� <br /> BUILDING AREA(if residential,new construction,remodel, or additiqn} 5F <br /> BUILDING TYPE: SFR-DETACHED � SFR-ATTACHED ❑ DUPLEX ❑MULTI-FAMILY-#OF UNITS: ❑ COMMERCIAL <br /> U5E OF BUILDING: <br /> �N.ECTRIGA,�:Ai�1�C.��dT1C�N3°�1��.filtMl�i"�`1t�N <br /> CONTRACT PRICE OF WORK: $ (� ,� <br /> NUMBER OF DEVICES if low vofia e : <br /> FIRE A�ARM? ❑YES ❑ NO <br /> AS50CIATED BUILDING PERMIT#(if a Hcable : <br /> QESCRiPTION S7F WDRK:___ _ �� _. <br /> ; <br /> Ct31�tACT iN�'QRIIlfdit"��tN <br /> OWNER NAME: � { r' TENANT NAME If Commarcial ; <br /> OW�IER MAILING ADDRESS: srReer �,'Cj, <br /> CfTY STATE �J� ZIP �[J�O 3 <br /> OWN�R PHONE: �?WNER EMAIL: <br /> CONTRACTOR NAME: �� <br /> CONTRACTORADDRESS: srReer ' � ,�Q� <br /> CttY � STkT[ � 21P � � G.D� <br /> CONTRACTOR PHONE: G CONTRACTOR EMAIL: , yN <br /> CnNTRA�TOFt LIC.#(R�QUIRED).C.YYt�'�,� � ��r7't CITY OF EVE3�ETT BUSINESS LIC.#REQUIRED: <br /> PRIMARY CONTACT: ❑OWNER CONTRACTOR �OTHER(Please Specify) <br /> GONTACT NAME; GONTACT PHONE: �+� ��G� �{� <br /> � '��,+��I� CONTACT EMAIL: �; •� �'�,�.�C1 -COYY� <br /> AGREEMENT:(hereby canify fha!!have resd and examinad fhls applicefron and know the same lo be frue and correcl. AI!piovlsions o/laws and o�dinances goveming fhis lype <br /> ol work w1116e completed whelher speclfied hereln or not. The granfing of a permil does nof presume to glve authority fo vJolafe or cancel fhe provlsJons of any ofher sfate or <br /> local law�egulating conslruc(!on or fhe perloimance o/consfruction. Thaf I am authorized by fhe owner of 1hls property to perform the work(or whlch appllcetlon is made and 1 = <br /> comply wilh fhe Sfa(e Confractors Law 19.27 RCW and 296.200 WAC. <br /> Clty ol Ev.ered OflJclal Use Only <br /> PERMIT# <br /> �-- - �`��� ����.�..�_� <<' I � �r� E �� < < � lo C� <br /> OwnarlAuthork ox d Agent Si8 ature Date (Revtsed 9/23/20i6) <br />