|
ELECTI�ICAL PER��T APPL�GATION
<br /> CITY OF EVERE7T PERMIT SERVICES
<br /> 3200 CEDAR STREET, EVERETT,WA 982�1
<br /> (P)425-257-8810 � FAX 425-257-8857 ( (E)everetteps@everetEwa.gov� www.everettwa.gov/permits
<br /> _ . .
<br /> ,. ..... .. [����..<. �'���� � �e ...'. ..... .. ...,. .... ....... ....
<br /> .._,. . , ...
<br /> ,. �.... . ..._ `� . �n,., �. �� �...':
<br /> ...... . ... ....... � , r�...�.,tw_, ...
<br /> •�.' - ..... .... . ...... .... . . ., ........ .:...... .. . .......
<br /> ':.. �-: ,.".. ' �" . . . ... .. ...
<br /> PROJECT ADQRESS; "' : ; �''`
<br /> _.
<br /> „ � .: _..
<br /> BUILDING AREA�-resldential,new�c��tst ,,r�,remodel,or���t�pr�): �F ,
<br /> _
<br /> BUILDING TYPE ` �f�=�ETACHED ❑SFR-ATTACHED , �,pUPLEX ❑MULTI-FAMILY-#_QF UNITS:. O COMMERCIAL
<br /> _.. . . - _
<br /> __.
<br /> tj��':OF BUILD{NG:
<br /> �vs�� °� <�t& �`�r ffi � � ������t � �
<br /> . .
<br /> ��� �� P •;� .f ,.,.� � ,,; ,
<br /> ���� ����� ���.
<br /> , ,, , , . �,,;� . ..A._ .o...,,_� ,.. �n.... ,r 3..,,. a. �z�.��
<br /> _
<br /> CONTRACT PRICE OF WORK: $ , d .,,a'
<br /> ,.. : .: ;
<br /> .: . - ,.:...._ .. _
<br /> NU..M..BER OF..,DEViCES ,�low vol., , :.
<br /> ,_ _ _.. . ..._ _._..
<br /> __ _ _
<br /> FIRE ALARM? IJ YES ❑NO
<br /> 1�Stt��tATED BUILDlNG PERM,R�#-. i.f�t . €i��l ': _
<br /> ���f�".��t3�!���� �;� '�'�''"`. *
<br /> z�,..,.� . _ z,.. ,�.,„ ..� :Y ID�.�. :� ..
<br /> a. , z.,
<br /> . .
<br /> r.,
<br /> rv .
<br /> , .,. �� ��'w` .. , ._ � � p- . . ' . __. � � __ _
<br /> ..� .a:. • ��
<br /> . ... . �. . .. . : d . :
<br /> : ... ..... :::...e ..,.. .. .� .. ,:
<br /> , :..� �v r. ..:..,.. . � �.�n v .�....�. . _a,r .. r ... ....,.
<br /> . . , ...� ....h., ..... . ,......... -�. ... ........ ..�..._,., -- . .... . ... ... .
<br /> .... . . ......... .. —
<br /> t+Vt�C�R NAME: < � ;�', TENANT NAME �Commerci�;
<br /> , ,^� :: _. ,.. , � .....
<br /> ,.
<br /> ,:
<br /> Ci1�t��i�MAILING AODRESS: STREET . •. 1 ,. ; , � _
<br /> ,.. ;..: ,. ,_ . �... . :
<br /> crtv > � ���. . _ ' � srn�, � ,,, ziP �
<br /> DWNER P ONE: ' ` ` , � _.:::. ..,,OWNER�MAIL: ;;
<br /> __ .._
<br /> ,::, .. .
<br /> ,,
<br /> _�1�t"I'R�C1'kJ�C;NAME: r ;
<br /> �
<br /> ; .: v . _. _
<br /> ���11'�t�C��AQDRESS. _ SSREET �... � �� . ` < :. __..
<br /> . ..... ... :,;,;
<br /> . ...._. ..,.::.. ,_. , ..,.�.�. .. . . . . ... ...
<br /> CITY '�.._ 6TATE ,�r�.,: . : ,.. 21P ',j� ... -
<br /> , ..,:� .........:.. .:.. .:. '... .. :� .... .., �
<br /> CONTFtACTOR PHONE �';f , �'�,�!°T±�'�����• � '��� `� r �.�
<br /> . _.. :: ,..
<br /> ::�,..
<br /> _.__.. �..... ,�... _.:;.� . .�,..:. `-�.<-.,�
<br /> „�s_ � �
<br /> ��'������1�[�.-' ; � � � CITY OF EVERETT BUSINESS UC #REQUIRED_
<br /> _. � . �� . __ .. . _ . . . _. �. _
<br /> _-.. . ,
<br /> PRIMARY CONTACT: ❑OWNER ;CONTRACTOR �07HER(Please Specify), . i =
<br /> , , _ �:..: _ � � ;. � �
<br /> :
<br /> CONTACT NAMEg �b��"�'PHONE :��; ���<q U{�'
<br /> � �i�u���_ CONTACT EMAIL _ _
<br /> _.. �
<br /> : *.
<br /> � 'r���"�
<br /> : .. . :
<br /> _. _ � ,:
<br /> AGREL�MENT:!hereby certify fhaf;have reed and examined thls appitcetion and Nnow Ihe same to be true end conect. AN provisFons of law's and ordinances goveming this lype
<br /> of work wN!6e wmplefed whefher speclffed herein or nok The granfing ot a permR does not presume!o pNe euthority!o vlofate ar censel!he provlslons of any otherstate or
<br /> tocal law regWaHng construction or(he perfamance o!conslruction. Thaf!am aulhoNzed by the owner o/thls property to perfarm fhe work tor whtch appllcaUon ts made and f
<br /> compty wlth!he State Conhactors Law 18.27 RCW and 296.200 WAQ
<br /> C@y of Evsrett 011lclel Use Only _
<br /> _- _
<br /> � �PERMlT#
<br /> , �
<br /> �� � � �� � ����-�� ��� ��a �i E t ���. - t
<br /> ��.�.... , �
<br /> � _ _ ,
<br /> t�+�next/kr,tthvri�wr.d Agent 5���� Date (hev/sed 9/2312U18)
<br />
|