|
�CTRICAL PERMIT A�ICATION
<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 � www.everetfinra.gov/permits
<br /> ' , � P�FC�J�G't:S�"��IN�QRM/�TION
<br /> ,
<br /> {.3,x���'.XT�'J,.`Y _ ' � - � - ra5k,.x
<br /> ,_, ,,,, , x„_ „n _. . , , . ,.. , , c.,, , ,, v,..,. . . .�,.,...,<<. ... .,, >� . > _ ,. ,. , i. . , ,
<br /> PROJECT ADDRESS: �(�J 3 (,(,(� C Ct S i�'I(� �C d
<br /> BUILDING AREA(if residential, new construction, remodei,or addition) �rar�es SF
<br /> BUILDING TYPE: ❑SFR-DETACHED ❑ SFR-ATTACHED ❑ DUPLEX ❑ MULTI-FAMILY-#OF UNITS: COMMERCIAL
<br /> USE OF BUILDING: (}?'�Ce./ MGt�'l U tCt C��G4!'1 G� j e I?vcc SC. (1L'I P.1�—
<br /> ' ' ,,�,;' .; � ��:.ELECTRICdL AP,PLICATION INFORMATtON� :y ;, z,.
<br /> . . . .
<br /> � . . . . _. . __ . , . ,
<br /> CONTRACT PRICE OF WORK: $ �3 3 �,� -
<br /> NUMBER OF DEVICES if low volta e :
<br /> FIRE ALARM? ❑YES NO
<br /> ASSOCIATED BUILDING PERMIT# if a licable): � �
<br /> DESCRIPTION OF WORK: .,�lec.z,`r-i�a.l l✓dt�+C � l� J�-�'�'le � ��.i� �A fJ�'
<br /> 64�Q��e a� z-o16 �- �ecc ��
<br /> '��l( cD n e-a c $- ui�r � �x ��r rrrr e cc rt e�- � ��t e r�r'�n i .
<br /> ; _ � � � . ;���� �.`. x. �co�ra�r�NFo�tnnarror�� ,
<br /> OWNER NAME: �v ei V) � /�'l q�1 TENANT NAME(If Commercial):
<br /> OWNER MAILING ADDRESS: STREET � " 3 0 .�'r, C. (��'{" �3
<br /> CITY SQ(���� STATE �y /T ZIP �Z `LL(/�
<br /> OWNER PHONE: �ZS 'Z 3R 'T Q S� OWNER EMAIL: d�.v� .� r �C/'� 8�-1 ` �G/YI
<br /> CONTRACTOR NAME: /V
<br /> CONTRACTOR ADDRESS: sTReeT
<br /> CITY STATE ZIP
<br /> CONTRACTOR PHONE: CONTRACTOR EMAIL:
<br /> CONTRACTOR LIC.#(RE(1UIRED): CITY OF EVERETT BUSINESS LIC.#(REQUIRED):
<br /> PRIMARY CONTACT: OWNER ❑CONTRACTOR ❑OTHER(Please Specify)
<br /> CONTACT NAME: CONTACT PHONE: �'L,�- 2.�3"1'3�(
<br /> �l(C�tJIR,' 1 �tn,V p�'1y' CONTACT EMAIL: /n 1 C�'l A�e. � l � !'�'1 Gtr/� }! �`�7''� ��'L
<br /> AGREEMENT:T hereby certify that 1 have read and examined this application and know the same to be true and correct. All provisions of laws and ordinances goveming this
<br /> type of work will be completed whether 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 /> loca/law regulating construction or the performance of construction. That 1 am authorized by the owner of this property to perform the work for which application is made and 1
<br /> compty with the State Contractors Law 18.27 RCW and 296.200 WAC.
<br /> City of Everett Official Use Only
<br /> FEE
<br /> ��—I �.� t�
<br /> PERMIT#
<br /> E c c�v ��- o�-�
<br /> Ow Authori d A i ature Date (Revised 10/12/2015)
<br />
|