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ELECTRICAL P�R�IT APPL�CATtON
<br /> CITY OF EVERETT PERMIT SERVICES
<br /> _... 3200 CEDAR STREET, EVERETT,WA 98201
<br /> (P)425-257-8810 � FAX 425-257-8857 � (E)everetteps@everettwa.gav( www.everetlwa.gov/permits
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<br /> : #�i���fCT ADDRESSe ` 1'h �J► : � . ::'
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<br /> ' BUILDJNG AREq�If�esldential,new construction,remodel,or���#�tta�s�. _ SF `
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<br /> BUtLDlHG TYPE: SFR-DETACHED ❑SFR-ATTACHED ❑DUPLEX ❑MULTI-FAlvllLY-#OF UNITS: ❑COMMERGIAL, '
<br /> USE OF BUILDING.
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<br /> +��NTRACT PRICE OF WORK: $ _ (� ,_pi°
<br /> �E�t����t OF..DEVICES t�f.ow v� :e: _ ,
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<br /> ��RE::ALARM? CJ YES �NO
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<br /> ���7CIATED BUILDtNG PERMIT# ��.•�����}�'� � _ x µ ,
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<br /> QWNER NAME: ,' - `° , ':; :' TENANT NAME �°,Comrtr�Xtzfal .....
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<br /> OWNER MAII.ING.ADDRESS: s.rn��r , . S� ;
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<br /> CRY,. ._.... , ,; ,,. ...__ STATE �' ZIP�:� �: ..' ': '�.
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<br /> CONTRACTOR NAME: � - ' � ,
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<br /> CONTRACTOR ADDRESS: . sTR��r � ';. � , , ��� `
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<br /> �t�t�TR,A�:3`t3f�PHONE. .' CONTRACTOR�A�4La ` _
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<br /> '"."� �C�i�7�'fi�'�'�"'L'TC.#(REQ IaE[5): ' x�.. .. CIT`!OP EVERETT BU'SIIVESS LlC.#(REQUIRED):
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<br /> PRIMARY CONTACT: ❑OWNER CONTRACTOR ❑OTHER(Please Speclfy)
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<br /> COMTACT NAME: �,"t}�V.7ACT RHONE: ; � ��G� D,
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<br /> AGREEMENT•f hereby cerfi(y that t have road and exemined this applicetfon and lmowlhe seme to be We end conecf. A!f provtsions of letva and ordlnances govemTng this lype
<br /> of work w!!t be compfefad whethar spec)fred hereln or not. The granling of a permlt does naf presume!o glve authalty fo vlolale or cance!the provlslons of any other s(ate or
<br /> loca!law regutat/ng cortstruc(ion or the peHormance of constroctlon. That�,am aufhorized by the owner of thls pmperty fo perform the work for whlch app�tca!!oo is made anB;i`
<br /> comply wl7h the Sfate Conhactors law 18.27 RCW and 298.200 WAC.
<br /> CJty of Evereft Olficlai Use Only
<br /> PERMIT#
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<br /> Own+et7`�k�tt�o�itt�Agent Signatu"r� ' "' Daie (Revlsed 9/23/ZOfB)
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