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ELECTRICAL PERMIT APPLICA��R�^
<br /> CITY OF EVERETT PERMIT SERVICES v''Y14�
<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:
<br /> BUILDING AREA(if residential,new construction,remodel,or addition) SF
<br /> BUILDING TYPE: ❑SFR-DETACHED SFR-ATTACHED ❑ DUPLEX ❑ MULTI-FAMILY-#OF UNITS: ❑COMMERCIAL
<br /> USE OF BUILDING:
<br /> ,;_���;4 � t'��"k,�����``;E�ECTRI�CAL APP�LIC�,ATr�I�-INFORNiAT10N Y ���a�,�,r.�,; F
<br /> CONTRACT PRICE OF WORK:$
<br /> NUMBER OF DEVICES if low volta e :.
<br /> FIRE ALARM? ❑YES ❑NO
<br /> ASSOCIATED BUILDING PERMIT# if a licable :
<br /> DESCRIPTION OF WORK: ��
<br /> � - � �`�'; , . _ ' � i(i��ilhi�q ��pi� . ,
<br /> � � ,� ��r,; ,rt �� � C�NTA��i',.,� 11!t�,�R�ATION � „ �.�;;�,�� �e��� � � 4�
<br /> OWNER NAME: �� TEN T NAME(If Commercial):
<br /> OWNER MAILING ADDRESS: sraeer �
<br /> CITY ,��j STATE V �/ IP
<br /> OWNER PHONE: '� �� OWNER EMAIL: � � � •�
<br /> CONTRACTOR NAME: �
<br /> CONTRACTOR ADDRESS: sTReer W � � V v �-
<br /> CITY STATE � V ZIP �
<br /> CONTRACTOR PHONE: • �� 7 CONTRACTOR EMAIL: t� 1
<br /> CONTRACTOR LIC.#(REQUIRED): � � CITY OF EVERETT BUSINESS LIC.#(REQUIRED):
<br /> z � �� rr. a . ,uA� ..� �, � , , �, . ., .
<br /> PRIMARY CONTACT: ❑OWNER CONTRACTOR ❑OTHER(Please Specify)
<br /> CONTACT NAME: CONTACT PHONE: 2. ��� � • � �
<br /> � � CC�� / v t��}" ( I Z CONTACT EMAIL:
<br /> AGREEMENT.•T hereby ceRity that I have read and examined this application and know the same to be true and correct. All provisions of laws and ordinances governing this
<br /> type of work will be completed whetiter 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/am authorized by the owner of this property to perform the work for which application is made and I
<br /> comply with the State Contractors Law 18.27 RCW and 296.200 WAC.
<br /> City of Everett Official Use On/y
<br /> FEE
<br /> � � �—
<br /> � PERMIT#
<br /> � `Z-I�t f 1� E l�2 r-C�2 �
<br /> Owner/A ori gent Sign re Date (Revised i0/12/2015)
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