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ELECTR�CAL PERMIT APPLICATION
<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.gov � www.everettwa.gov/permits
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<br /> PROJECT ADDRESS: �� � L:�i '���r�t'_- � t`; 1 �(rj f' `
<br /> BUILDING AREA(if residential, new construction, remodel,or addition) ���-1r �� SF
<br /> BUILDING TYPE: ❑ SFR-DETACHED ❑ SFR-AT CHED ❑ DUPLEX ❑ MULTI-FAMILY-#OF UNITS: ,COMMERCIAL
<br /> USE OF BUILDING: ��.1'•_:�-C� .
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<br /> CONTRACT PRICE OF WORK: $ S ��C�`��.
<br /> NUMBCR OF DEVICES (if low voltage): �;`,.� �;
<br /> FIRE ALARM? ❑YES NO
<br /> ASSOCIATED BUILDING PERMIT#(if applicable): �� �...� '"'�
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<br /> DESCRIPTION OF ORK:� �� �� �� , _ 1�,�J
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<br /> ��NTAGT IIVFOR'N!k'�`i�1�1
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<br /> OWNER NAME: � .`�.,n,�- �,,� ' � ('ti,::.c``t� TENANT NAME(If Commercial): ���,�..c^�-�_.:.(�:1,r ._ .c � t,1� .
<br /> OWNER MAILING ADDRESS: srREET
<br /> CITY STATE ZIP
<br /> OWNER PHONE: � ,r��' � � -�
<br /> �,�;, �T � ,,�.�' ,� OWNER EMAIL:�: :.�ti``s !1 ^ L`a���.�. � a., �'_ t'.. � C��`�rro�
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<br /> CONTRACTOR NAME: �'.._.�/' �� ��-�r_-`C '�' '.� - .` 1'J� C�
<br /> CONTRACTOR A�JDRESS: sTREEr � ' �,r'�'` _ � � �
<br /> CIN ��� vv�-�rv STATE �,j �' ZIP ��� � �
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<br /> CONTRACTOR PHONE: ,�',,��- (,, ���I '(„ �-' '-CONTRACTOR EMAIL: • �-�'�_ ;.• �;ti��:,T'(�,�c-�;-�/ ` � � , ' ` ,�I�y""�
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<br /> CONTRACTOR LIC.#(REQUIRED): l �L,,.;'r C�'�'__ '��� �L_.-�� CITY OF EVERETT BUSINESS LIC.#(RE IRED): �I�
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<br /> PRIMARY CONTACT: ❑OWNER `�CONTRACTOR ❑ OTHER (Please Specify) �`�
<br /> CONTACT NAME: CONTACT PHONE: �� -3-� (�, �� - _ � �= ,� - - _ - —
<br /> �^t'�-�...�--�_L f,'�'��`��i.�- CONTACT EMAIL: �S'S�;.e'� � C. � ° (CC.-` � � . .�.�.� �
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<br /> AGREEMENT:1 hereby certify that I have read and examinc�/this application and know the same to be true and correct. All provisions of laws and ordinances governing this type n��
<br /> of work will be completed whether spc�ifred herein or not. The granting of a permit does not presume to give authority to violate or cancel the provisions of any other state or
<br /> local law r�ulating construction or the performance of constructron. That l am aufhorized by the owner of this property to perfwm the work for which application is made and 1
<br /> comply with the State Contractors Law 18 27 RCW and 296.200 WAC.
<br /> City of Everett Officral Use Only
<br /> PERMIT#
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<br /> ' Oavner/Authorized Agent Signature Date (Revised 9/23/2016J
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