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ELECTR�CAL PER1��T APPL�C�4�'10N
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<br /> CITY OF EVERETT PERMfT SERVICES
<br /> 3200 CEDAR STREET, EVERETT,WA 98201
<br /> (P)425-257-8810 J FAX 425-257-8857 � (E)everetteps@everettwa.gov� www.everettwa,govlpermits
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<br /> PROJECT AD.AR�SS: �; : , . , : , ;:
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<br /> �#�tLDING.AREA(if resfdentlal,new construction,remodel,or.ad�f{tiw�t} ;8F ,
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<br /> �t�,t9MG TYPE. ❑ SFR-DETACHED,_ l7 SF.R..-A7TACHED ❑QUPLEX I�MULTI-FAMILY-#.Q.F UNIT�: CJ G9MMERCIAL
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<br /> ��:OF BUILbING:
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<br /> GONTRACT PRICE OF WORK:$ , (� .°'D _ ,
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<br /> NUM��R OF.DEVIGES if,I.o..w.v.otta e :
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<br /> �IRE ALARM? ❑YES �NO
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<br /> ASSOCIATED BUILDING PERMIT_# if a I(cable °;:.
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<br /> DESCRIPTION OF WORK: =� '_ _._ , � '; ��. . ;
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<br /> DWNER NAME: ��� � �.� ` -�'.` :' TENANT NAME tt:Cr�rt� �rt��i�> � _. �'�
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<br /> OWNER MAILlNG ADDRESS:.:.: arR�ET �! ' P,.� ;
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<br /> CITY . ,: ; ' � . STATE � � .-,� ZIP '��, �
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<br /> CONTRACTOR NA,NI�y = ' �.` . . :�.- _ ;
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<br /> CONTRACTOR ADDRESS; sTREET ` ' �,-,; '� ,. �. � ' -
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<br /> #}N�`R�4�.T.QJ�PHQNE. , CONTRACTOR�M1�li;; ':: � : .. r YY1 r.
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<br /> 4?NTRACTOR LIG �i�Ql�{�i CYI1T�� �'�� CITY t)F�VERETT B.USINES$.I.(C..#��t�U�l��'
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<br /> PRIMARY CONTACT: CJ OWNER �CONTRACTOR �OTHER(Please Specity) ,__
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<br /> CONTACT NAME: �?�'t'�1CT PHONE:
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<br /> AGREEMENT.�!here6y certlfy lhat 7fave reed and examined thls applkedon and know the same to be lrue and correct. Ail provlslons ollaws end ordlrrances goveming fhis type
<br /> ol work wltt be comp/eted whather specJt�ed hereln or not. The grenlfng of a pemtH does�ot presume to glve au(hodty to vlolafe or cance!the provlsions of any other state or
<br /> loca!taw reguteltng constntcNon or(he peNormance of conslruction. That!am aufhorized by Ihe owner of Ih/s propetty lo perform ihe work for wh/ch epppcallon 1s made ead i
<br /> comply wtth Iha Sfate Contracfors taw 18.27 RCW and 296.200 WAC.
<br /> , _, CIIp of EvereN OH/dal Use Only
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<br /> PERMIT#
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<br /> OwnertAu�hKri'i�ad Agent�fy�tysCuri� .. ; _ - Date (Itevlsed 9%23/20161 :
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