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�LECTRICAL PERN[IT AP�LICATION
<br /> GITY�F EVERETT PERMIT SERVICES
<br /> 3200 CEDAR STREET, EVERETT, WA 98201
<br /> (P}42�-257-8810 � FAX 425-257-8857 J (�}everetteps@everettwa.gov� www.everetfinta.gov/permifs
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<br /> <PROJ,ECT;SMTE:Ii�FCRMATICN .>:
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<br /> PROJECTAbDRESS; , : �� . ��,�.�.'
<br /> BUILDING AREA(If residential;new canstruetion,remodeE, r additiort) �� SP
<br /> BU[LDINCr TYPE: ❑SFR-DETACHED ❑SFR-ATTACHED ❑DUPLEX ❑MULT[-FAMILY-#OF E1N1TS: '+�OMMERCiAL
<br /> USE(��BUfi.DING: t.'•-��k,-t�.a�.r` � �F--�..-�
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<br /> ; � ;ELECTRtCAL;.APPLICATIQN:'l,NFORAl1A:T.1�N
<br /> CONTRACT PRIGE OF WORK: $ � ; Z�
<br /> NUMB�R O�DEVICES if low volta e :
<br /> F1RE A�.ARM? ❑YES NO
<br /> ASSOGIATED BUILDt�tG PERMiT#{if applica6le :
<br /> b�SCRiPTION OF WORK: G� -'y� � . -�-s''-��e1.'�.s%`
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<br /> , CONTACT'INF'ORMATI�N '
<br /> OWN�R NAME: ,..��-tr��.� � T ANT NAME(If Commercial): '�--�`���
<br /> QWN�R MAIt,fNG ADDRESS: STREET � `�'�-` �,...�..!' •� � ,�� �
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<br /> CI'IY � �,.�� 6TATE ZIP ��
<br /> OWNER PHaNE: OWN�R�MAI[,:
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<br /> CONTRACTQFt NAME: ��I` . � . . ,( .-�
<br /> CONTRAC70R ADDRESS: STREET� � � � .--� _..��lo�'`
<br /> C]N -"�t, STA7� ` ZIP
<br /> CONTRACTOR PHONE• �I:�"?o`�`:�/ CON7RACTOR EMAIL: l.�.,��..�-� ' 1. „
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<br /> COi�[TRAC�OR LfC.#{REQt1�RED): C��-Z� � .S ��` CITY OF EVERETT SUSINESS L1C.#(REQU� Cs)c .�� �
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<br /> PR(MAFtY CONT'ACT: ❑OWNER ❑CONTRACTOR Cl�THER(Please S�ecify) �
<br /> C�N'fACT NAM�: GQNTACT PHONE: " C� " . �;t, �
<br /> ��,,(,f �.�,�-�-�'� CONTACT EIVIAIL: ��,,,�; .
<br /> AGRE'EMENT.•T hereby erfify fhaf!have read and examrnad fhis appJication and lmow fhe same to be true and correcf. Al/provisions of laws d ordinances govemtng this
<br /> type of work w1t!be completed w/tether specified herein or nof. The grandng of a permit does nof pr�sume fo give aulhnrity to vlolafe or cance!he provfstons of any other sfate or -
<br /> local law regulafing construction or the performance of consirucfion. Thaf 1 am aufhorized by lhe owner of thls prope�[y fo perfnrm the work for whioh app!lcaflon�s made and!
<br /> oompty with fhe State Contractors Law 18.27 RCW and 296 200 tNAG
<br /> City of EvereB OfffciaJ Use oniy
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<br /> PERMIT#
<br /> .�� .ir , � E �t��� - �3(�
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<br /> Owner/Aufhorized Ag� t S(gnature Date (Revlsed 10/9?J2015) �
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