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�ECTRICAL PERMIT AP�ICATIDN <br /> CITY O� EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT,WA 98201 <br /> (P)425-257-8810 � FAX 425-257-8857 � (E)everetteps@everettwa.gov� www.everettwa.govipermits <br /> ' PR'�ld�CT$ITE INFO�tMAT10N <br /> PRi�JECT ADDRESS: \ <br /> BUIl.DING AREA(if residential, new construc#ion, remodel,or addition) SF <br /> BUILDING 1'YPE: o SFR-DETACHED o SFR-ATi'ACHED a DUPLEX o MULTI-FAMILY-#OF UNITS: C�MMERCIAL <br /> USE OF BUILDING: �� a���\�'� `�Q,��,�� Q+(1� ��-� �-e, u,�, <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK:$ <br /> NUMBER OF DEVICES if low volta e : <br /> FIRE ALARM? YES o NO <br /> ASSOCIATED BUILDING PERMIT# if a licable): <br /> DESCRIPTION OF WORK: \ ��,� \ ��� \V� <br /> � Y'Z'.Y.�V� <br /> CQNTACT INFORMATION <br /> OWNER NAME: TENANT NAME If Commercial : �Q\ � � }i� <br /> OWlVER MAIUNG ADDRESS: STREET� ��, �'�' Q�,�\ ���, <br /> cirr sTn� � zia 6 <br /> OWNER PHONE: U���j��LI.�� OWNER EMAIL: <br /> CONTRACTOR NAME: � � re��T" <br /> CONTRACTOR ADDRESS: STREET ��� �} � <br /> ciN � STATE � zia� \�� <br /> CONTRACTOR PHONE•� CONTRACTOR EMAIL: <br /> CONTRACTOR UC.#(RE(1UIRED)�������� CITY OF EVERETT BUSINESS LIC.#(REQUIRED}:����� <br /> PRFMARY CONTACT: o OWNER o CONTRACTlJR OTHER(Piease 5pecify) . \��� <br /> CONTACT NAME:�=y-,n\n� 4,���� GONTACT PHONE: , �� <br /> �J��-.� <br /> CONTACT EMAIL: � �"��"�LQ����1� �(,� <br /> AGREEMENT.�1 hereby cerfify that/have read and examined thfs apptication and know fhe same to be tn�e and correct. 1 provis,ions af taws and ordinances governing this type <br /> of work wili be comp/eted whether speci�ed herein or not. The granfing of a permit does not presume to give authorify to vio/ate or cance!the provisions of any other state or <br /> loca!law reguJating construction or the performance of construction. That 1 am authorized by the owner of this property to perform the work for which application is made and i <br /> comAly with the State Contractors Law 18.27 RCW and 296.200 WAC. <br /> City of Evereft O�cial Use Only <br /> � PERMIT# <br /> i � ���; E �gof -oz5 <br /> Owner/Authorized Agent Slgnature Date (Revised 9/23/2016) <br /> 1� <br />