|
�t
<br /> �ECTRICAL PERMIT APPLICATION
<br /> CITY OF EVERETT PERMIT SERVICES
<br /> 3200 CEDAR�STREET, EVERETT, WA 98201
<br /> (P)425-257-8810 � FAX 425 25T-8857 � (E)everetteps@everettwa.gov� www.everettwa.gov/permits
<br /> .. ._.
<br /> ... , ...
<br /> PROJECT SITE INFORMATION',' `
<br /> .... . ... . ....... . .. ....
<br /> PROJECT ADDRESS: � �"r' s� � . `
<br /> Z(� . _.. �
<br /> BUILDING AREA(if residential,new construction,remodel,or addition) SF �
<br /> BUILDlNG TYPE: ❑SFR-DETACHED ❑SFR ATTACHED ❑DUPLEX �MULTI-FAMILY-#OF UNITS: ❑COMMERCIAL
<br /> USE OF BUILDING: f f(., .� � j„
<br /> ,. ;.. .. -
<br /> .. . ,
<br /> ,
<br /> , ELECTRICAL APPLICATION INFORMATION - ; .
<br /> ... .. ,
<br /> : .. : :
<br /> CONTRACT PRICE OF WORK:$ .
<br /> NUMBER OF DEVICES(if low voltage :•
<br /> FIRE ALARM? ❑YES ❑NO -
<br /> ASSOCIATED BUILDING PERM(T#(if applicable):
<br /> DESCRIPTION.�OF WORK: C.i� t��1 ,as�7� �',.� � .�.
<br /> -. ,
<br /> . ,
<br /> _.
<br /> ..
<br /> . , ,. . CON'I'ACT INFORNIATION . '
<br /> .
<br /> . . :
<br /> OWNER NAME: �j���G ' TENANT NAME(If Commercial): (
<br /> OWNER MAILING ADDRESS: srREer�� -�l Z''� S
<br /> ClTY STATE'�� LP
<br /> OWNER PHONE: OWNER EMAIL:
<br /> . ... : ...... .. .. .... . . . ... . .. ... .. ... . . . ...F.. .
<br /> . . . . .. . ... . .. . .. .. . . _. . .... .. .. .., ...
<br /> CONTRACTORNAME. ��r L "'("��J � V�,(�S
<br /> CONTRACTOR ADDRESS: Z � � �V�' �
<br /> b ������� �ts �t �A�` W -�
<br /> ZIP
<br /> CONTRACTOR PHONE: Ck.Z��L1 C�'-SZ CONTRACTOR EMAIL: -S �-t� .4�Z� e�� � �y�
<br /> CONTRACTOR LIC.#(REQUIRED): ��c � c� Pl/�,3 CITY OF EVERETT BUSINESS LIC.#(REG2UIRED�I�� ��
<br /> w�...,........,�.,...,......................�......,,_.�..w_:.....x�...«..W.�..�...,.,....,....,�.:.�..,.W.,.r,�.�..,�,�..:�.,.�b....�....n...:,....»n..._,..,N�.,.,_..:..,,..,,,.,�-.
<br /> PRIMARY CONTACT: ❑OWNER ONTRACTOR ❑OTNER(Please 5pecify) '
<br /> CONTACT NAME: CONTACT PHONE: �'.-Z��„k�Z2� �
<br /> ,J C��L NEJC(� CONTACT EMAIL: ,.SC.N Io3Z-S �. �ST�J � Gt�'V,J�,
<br /> AGREEMENT.•T hereby cerli(y that/have read and examined this application and know the same to be true and correct. AJI provisions oflaws and ordinances governing this
<br /> type of work wi/I be compfeted whefher spec�ed herein or not. The granGng of a permR does not presume to give aufhority to violate or cancel the provisions of any other state or
<br /> loca!law regulating construction or the perfo�mance of construction. Thaf l am authorized by the owner of this properfy to perform the work for which application rs made and 1
<br /> comply with the State Confracfors Law 98.27 RCW and 296 200 WqC.
<br /> City of Everett Official Use Only
<br /> � FEE
<br /> S� - SC�
<br /> PERMIT#
<br /> -��.�_ LZ- �-� �,.� E l c�(2 — 0�.S
<br /> OwnedAuthor dA ntSignature Date (Revised90/12/2095)
<br />
|