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<br /> ELECTRICAL PERMIT APPLICATION
<br /> GTY 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: C� 'rJ �'I Ztll St SE
<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 Bui�niNc: 581 Eating Places (Restaurants)
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<br /> CONTRACT PRICE OF WORK:$7'�Or �
<br /> NUMBER OF DEVICES if low volta e : �
<br /> FIRE ALARM? ❑YES �NO
<br /> ASSOCIATED BUILDING PERMIT# if a licable : B1709-020✓
<br /> DESCRIPTION OF WORK: Disconnect and reconnect of lights on an awning that will be recovered with no graphics.
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<br /> OWNER NAME: EZell St2ph2nS TENANT NAME(If Commercial): HeBVen S211t FPI2d ChiCk2n
<br /> OWNER MAILING ADDRESS: sTaEer 615 112th St SE
<br /> cirv EVerett srnTe WA ziP 98208
<br /> OWNER PHONE: 206-353-6H58 OWNER EMAIL:
<br /> CONTRACTOR NAME: Raltll@I'If1dUStrIG'S
<br /> CONTRACTOR ADDRESS: sTReer�$37S OIy171pIC AV@ $
<br /> cin.Tukwila sra� WA ZiP 98188
<br /> CONTRACTOR PHONE: CONTRACTOR EMAIL:
<br /> CONTRACTOR LIC.#(REQUIRED): �INIIL94HQF CITY OF EVERETT BUSINESS LIC.#(REQUIRED): OZ3736
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<br /> PRIMARY CONTACT: ❑OWNER ❑CONTRACTOR Q1 OTHER(Please Specify)�lectrical Administrator
<br /> CONTACT NAME: CONTACT PHONE: 425-998-3947
<br /> Brad Ehlers - ELECT ADMIN coNTacT eMai�: brade@rainier.com
<br /> AGREEMENT.1 hereby certify that I have read and examined this application and know the same to be t[ue and correct All provisions of laws and ordinances governing this fype
<br /> of work wil!be completed whether specified herein or not. The granting of a permit does not presume to give authority to violate or cancel the pr0�+sions 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 /> compry with the State Contractors Law 18.27 RCW and 296.200 WAC.
<br /> City of Everett O�cial Use Only
<br /> PERMIT#
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<br /> Owner/Author' ed Agent Signature �Date (Revised 9/23/2016)
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