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<br /> £ ELECTRlCAL PERMIT APPLICATIQN
<br /> C: C1TY OF EVERETT PERMIT SERVICES
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<br /> ' 3200 CEDAR STREET, EVERETT, WA 98201
<br /> ` (P}425-257-8810 � FAX 425-257-8857 � (E)everetteps@evereitwa.gov� www.everettwa.gov/permits
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<br /> P120JECT ADDRES;i: Z O S�IV �V E R��T I'�`--�--- W!"C EVE�ETT'�Y .�q g2o4
<br /> r' BUILDING AREA(if residential,rsew construction,remodel,ar addition) SF
<br /> �� BUILDING TYPE: ❑ SFR-DETACHED ❑ SFR-/ATTACHED � DUPLEX ❑ MULTI-FAMILY-#OF UNITS: COMMERCIAL
<br /> USE bF BUILDING: ��,T A, (_
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<br /> COIV7RACT Pf210E OF WORK: $ (�b C�
<br /> � NUMBER OF DEVICES if low vo a e :
<br /> �� FIRE ALARM? ❑YE5 �'`� N. �"`
<br /> ASS�CIATED BUILDING PERMIT# if a licable : N
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<br /> k DESCRIPTION OF WORlt: � ti s "t'�,�' S x^ �
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<br /> � OWNER NAME. TENANT NAME(If Commercial�: W S`�"� S Q S
<br /> � OWHER MAILING ADQRESS: STREET
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<br /> � � CITY STATE � ZIP
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<br /> ` OWNER PHONE: OWNER EMAIL: �
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<br /> CONTRACTOR NAME: � LEC�� '""' C L €
<br /> CONTRACTOR ADDRESS: STREET 12q 2 E V� L � �
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<br /> CONTRACTOR PHONE: 2, (0 2, ""J CONTRACT012 ENtAIL: }S r�,�� -- C - G. s
<br /> f CONTRACTORlIC.#{REQUIRED): �LEC�T 1 � 1_1 O L7� CITYOFEVERETT BUSINESS LIC. EQUIRED O2� �3 �
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<br /> � PRIMARY CONTACT. ❑OWNER CONTRACTOR ❑07HER(Please Specify)
<br /> � CONTACT NAME: CONTACT PHONE: 42 ^ 2,— �O j �
<br /> ' ���'Sy� �Z�C LZ�'t��s� CONTACT EMAIL:
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<br /> AGREEMENT:T heieby certlly that!have read and exam�ned mis appllcaUon artd imow fhe same to be true and cavrecf. A11 provisions oflaws and ordlnances gov�mfng this �
<br /> type of Nollt wiN be c»mpleted whetherspecilled helein or not The granth�g of a Aemrt does not presume ro gn,s authority to violate or cance!the pmvislons of any other state or iii
<br /> locaf law regulating consbuctbn or the perfomiarroe of constradJon. 7riat!am authaized by the owner of this property to pertwm the uwAc for which appiicatron is made and 1 �
<br /> aoll;Dry w�th ihe State Contrectors Law 78.27 RCW and 296.200 WAC,
<br /> City of Evefetf OBicial Use Only �
<br /> FEE
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<br /> PERMIT# �
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<br /> Own thorized Agent Signature Date (Revised 10/12/2015j
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