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<br /> ECTRICAL PERMIT AP�CATlON
<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 J www.everettwa.gov/permits
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<br /> ' PROJECT SITE INFORMATION ` '
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<br /> PROJECT ADDRESS: �"�' $� � � (�Z� . . .�
<br /> BUILDING AREA{if residential,new construction,remodel,or addition) SF �
<br /> BUILDING TYPE: ❑SFR-DETACHED ❑SFft ATfACHED ❑DUPLEX R MULTI-FAMILY-#OF UNITS: ❑COMMERCIAL
<br /> USE OF BUILDING: ��, .� µl �
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<br /> ` ELECTRICAL APPLICATION INFORMATION � •
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<br /> CONTRACT PRICE OF WORK:$ .
<br /> NUMBER OF DEVICES(if low voitage :>
<br /> F1RE ALARM? ❑YES C7 NO -
<br /> ASSOCIATED BUILDING PERMIT# if appiicable):
<br /> DESCRIPTION.OF WORK: C.Z b� ,as�7� �� J� -t.
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<br /> . : ; . : ... CONTACT INFORMATION
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<br /> OWNER NAME: �N�Y�C ' TENANT NAME(If Commercial): �
<br /> OWNER MAILING ADDRESS: sraEEr� -���.'� S
<br /> C1TY STATE'W� ZIP
<br /> OWNER PHONE: OWNER EMAIL:
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<br /> CONTRACTORNAME: ��r L "r"(I�J ^ VI.C.�S
<br /> CONTRACTOR ADDRESS: ���� � �L(� �
<br /> a CI�F'`C L���V�� !�"'�S � STATE W �
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<br /> CONTRACTOR PHONE: Ck2��Z7 C.�.�-SZ CONTRACTOR EMAIL: --, �—t-� .`�Z� e,�� � �.y,,�
<br /> CONTRACTOR LIC.#(REQUIRED): ��c � c� �l/l,3 CITY OF EVEI2ETT BUSINESS LIC.#(REQUIRED):
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<br /> PRIMARY CONTACT: ❑OWNER ONTRACTOR ❑OTHER(Please Specify)
<br /> CONTACT NAME: CONTACT PHONE: ��Z�a.��Z2L •
<br /> J U�C. NE�j� CONTACT EMAIL: �+[,�J (o3ZS � �Sl�l � G�,�./��
<br /> AGREEMENT.•T he�eby certify that/have read and axamined this application and know the same to be true and correct. AI!provisions of/aws and ordfiances governing this
<br /> type of work will be completea'whefher specified herein or noL The granting of a permit does not presume to give authority to violate or cancel the provisions of any other stafe or
<br /> local law regulating construcfion or the performance of construction. That l am authorized by the owner of this p�operty to perform the work for which application is made and l
<br /> comp/y with the State Confrectors Law 18.27 RCW and 296.200 WAC.
<br /> City of Everett O�cial Use Onty
<br /> • FEE
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<br /> PERMIT# j (�
<br /> - �2- �� -�.� E � c.oc 2 �--��K
<br /> Owner/Aufhor' dA entSignature Date (Revised90/12/2015)
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