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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 /> PRo�eeTao�Ress: 4904 COLLEGE AVE EVRETT, WA 98201
<br /> BUILDING AREA(if residential,new construction,remodel,or addition) SF
<br /> BUILDING TYPE: ❑SFR-DETACHED 0 SFR-ATTACHED ❑ DUPLEX ❑MULTI-FAMILY-#OF UNITS: ❑COMMERCIAL
<br /> USE OF BUILDING: SF LIVING
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<br /> CONTRACT PRICE OF WOR $ 1500
<br /> NUMBER OF DEVICES(if low Itage):
<br /> FIRE ALARM? ❑YES 0 O
<br /> ASSOCIATED BUILDING PERMI ' applicable):
<br /> DESCRIPTION OF WORK: GROUNDING AND BONDING
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<br /> owNeR Nanne:JERRY SMITH TENANT NAME(If Commercial):
<br /> OWNER MAILING ADDRESS: sTReer 4904 COLLEGE AVE
<br /> cin. EVERETT STATE VV� ziP 98201
<br /> owNeR PHONe: 425.346.5829 OWNER EMAIL:
<br /> coNTRacroR Nanne: IN HOUSE ELECTRICAL SERVICES, INC.
<br /> CONTRACTOR ADDRESS: sTReeT 1530 117TH DR SE
<br /> �in.LAKE STEVENS STATE VV� ziP 8
<br /> CONTRACTOR PHONE:4Z�J.T6O.3203 coNTwacroR eMa�: IHEPERMITS@GMAIL.COM
<br /> CONTRACTOR LIC.#(REQUIRED): INHOUES9rJZQG CITY OF EVERETT BUSINESS LIC.#(REG1U eo�:044168
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<br /> PRIMARY CONTACT: ❑OWNER 0 CONTRACTOR ❑OTHER(Please Specify)
<br /> CONTACT NAME: CONTACT PHONE: 4Z'rJ.76O.3ZO3
<br /> KELSEY coNTacr enn,v�:�HEPEREMITS@GMAIL.COM
<br /> AGREEMENT.•l hereby certify that I have read and examined this application and know the same to be true and correct. All provisions of laws and ordinances governing thrs type
<br /> of work will be completed whether specified herein or not. The granting of a pe�mit does not presume to give authority to violate or cancel the provisions of any other state or
<br /> local law regulating construction or the performance of truction. That I am authorized by the owner of this property to perform the work for which application is made and l
<br /> comply with the State Contractors Law 18.27 RCW d 296. 00 WAC.
<br /> City of Everetf Official Use Onty
<br /> PERMIT#
<br /> (�� I�� I�' E 1�2.-- 12. �
<br /> Owner/Authorized Agent Signature Date (Revised 9/23/2016)
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