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DEC-09-2017 05: 1z From: �.�252578857 Pa9e:2�2
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<br /> ELECTRICAL PERMIT APPLfCATION
<br /> CITY OF EVERETT PERMIT SERVICES
<br /> 3200 CEDAR STREET, EVERETT, WA 98201
<br /> (P)425-257-8810 ( Fl�1X 425-257-8857 � (E)everetteps@everettwa,gov � www.everettwa_gov/permits
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<br /> PROJECT ADpR�SS:
<br /> BUILDING AREA(if resitlential, neW COnstructi0n, �emode,or additi0n) SF
<br /> BUILDING TYPE: ❑ SFR-pETACHED �SFR-ATTACHED ❑DUP�EX ❑MULTI-FAMILY-#OF UfVITS: ❑COMMERCIAL
<br /> USE OF BUILdING: -
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<br /> .�ELEC7RIC 'L�.A'PPLiC� ;ION.INFOItM4,T10N,- �: '�.,. '; �,��
<br /> CONTRACT PRI .� � ,�
<br /> C� OF WORK:$ �, p
<br /> NUMBER OF DEVICES if low voll e : _�
<br /> FIRE AIARM? ❑YES NO
<br /> ASSOCIATED BUILDING PERMIT# if a lic�ble :
<br /> DESCRIPTION OF WORK: � ; -� rn ` GO
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<br /> OWNER NAME: � �('S TENANT NAME If Commercial :
<br /> OWNER MAILING ADDRESS= sTaEEr ��yy�. �� �
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<br /> STATE 7,IP
<br /> OWNER PHONE: 5� —�.�a3 OWNER EMAIL:
<br /> CONTRACTOR NAME: LG ' r-' �,.�
<br /> CONTRACTOR ADDRESS: srR�Er AU S#' S�
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<br /> CONTRACTOR PHONE: � — � Q CONTRqCTOR EMAfL: �;a�- �... G
<br /> GONTf�ACTOR LIC,�REQUIRED): CITY QF EVERETT BItSINESS�IC.#(REQU! ED):
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<br /> PRIMARY CONTACT: �OWNER ❑CONTRACTpR ❑OTHER(Please Specify)
<br /> CONTqCT NAME: CONTAGT PFiONE: L f� .J�' ,,.3 c..� �
<br /> 1 L' PG S CONTAC7 EMAIL:
<br /> AGRE�MENT.-I here0y Gcrfify lhat I heve�C&tl�r�d examined inlg BpOJiCafion and know fhe geme!o Aa tr'ue and carrect. Ai!provfsiOnS oflaws and ordinances goveming tAfs fype
<br /> 01 wprk wi0 be comptelgt!WHB1her specifiea�erein or not. The giaRling o!a permft does nof presume Co give authonry fo��olate or canCol tHe provisions af dRY olher stale Of
<br /> local law iequfaring constniet�on ar the pe+farmanee of consrrucrion, Trt�i J am authorized by the OwnEr di this propeity to perform!hg woyk for which application is mede ano!
<br /> comp/y WI1J11he Slate Conf/eCtots Law 98.27 RCyy 8ntl 296.200 WAC.
<br /> Cily of Evereft Oftroi�l Use Only
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<br /> C� /J PERMIT#
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<br /> OwrrerlAuthoriz9d Agent$ignature Date (Revised 8/23/20�6)
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