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ELECTRICAL PERMIT APPLICATION
<br /> CITY OF EVERETT PERMIT SERVICES
<br /> 3200 CEDAR STREET, EVERETT, WA 98201
<br /> (P)425-257-8810 � FAX 425-257-8857 � (E)everetteps@everetfinra.gov � www.everettwa.gov/permits
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<br /> PROJECT ADDRESS: Gj Z Vv� ��V��iTJ � f/�/ �ZO/
<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: �'.� ��/'/��
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<br /> CONTRACT PRICE OF WORK: $
<br /> NUMBER OF DEVICES(if low voltage):
<br /> FIRE ALARM? ❑YES NO
<br /> ASSOCIATED BUILDING PERMIT#(if ap licable):
<br /> DESCRIPTION OF WORK: � 15� � l� 1 {� ,2 / G7�S
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<br /> �� �� ,5.f ,��, ,,,..� �:., � �,%Yn$ �£ �'�",q��'�'�N� ��T1�3 � E�/a �/� �r \y �l� �y
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<br /> OWNER NAME: T� S� TENANT NAME(If Commercial):
<br /> OWNER MAILING ADDRESS: srReer 2,2. 1`� v�='
<br /> ��n. EVERETT STATE V V^ ZIP '�- �ZD I
<br /> OWNER PHONE: �,/I,Q C�• ��'. —C v�� OWNER EMAIL:N/A
<br /> coNrRacroR NaME: IN HOUSE ELECTRICAL SERVICES, INC.
<br /> coNTwacroR d��Ress: STREET 1530 117TH DR SE
<br /> �in.LAKE STEVENS STATE WA ziP 98258
<br /> CONTRACTOR PHONE:4ZrJ.TGO.32O3 coNrRacTOR eM,v�: IHEPERMITS@GMAIL.COM
<br /> coNTRacroR uc.#�REQuiReo>: INHOUES952QG CITY OF EVERETT BUSINESS LIC.#(REQUIRED):044�CH
<br /> PRIMARY CONTACT: ❑OWNER 0 CONTRACTOR ❑OTHER(Please Specify)
<br /> CONTACT NAME: CONTACT PHONE: 42rj.76O.3ZO3
<br /> KELSEY coNracr eMa�:IHEPERMITS@GMAIL.COM
<br /> AGREEMENT:I herebycertify that I have read and examined fhis application and know the same to be true and correcL All provisions of laws and ordinances goveming fhis type
<br /> of work will be completed whether specified herein or not. The granting of a permit does not presume to give authority to violate or cancei the provisions of any other state or
<br /> local law regulating construction or the performance of construction. That I am aufhorized 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 Evereft O�cia/Use Only
<br /> PERMIT#
<br /> E �.�-c 2 �- �� i
<br /> Owner/Aut rized Age t Signature Date I� I n �' I� (Revised 9/23/2016)
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