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E�TRICAL PERMIT APPL�ATION
<br /> CITY OF EVERETi"PERMIT SERVIGES
<br /> 3204 CEDA _ ETT, WA 982Q1
<br /> (P)425-257-8870 � FAX 425-257-8857 � everetteps@everettwa.ga � www.everettwa.govlpermits
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<br /> PROJECT ADDRESS: /
<br /> BUf�DIN(3 AREA(if residerrtial,new constructEon,rem el,nr addition) SF
<br /> BUILDING TYPE: ❑SFR-DETACHED ❑S�R-ATTACHED ❑DUPLEX ❑MULTI-FAMILY-#�F UNITS: �MMERCIAL
<br /> USE OF BUILDIN{3: e r�
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<br /> CONTRACT PRICE OF WORK: $
<br /> NUMBER OF DEVICES if low volta e :
<br /> FIRE ALARM? ❑YES O NC>
<br /> ASS4CIATED BUILDING PERMIT# if a licable : .
<br /> DESCRIPTtON OF WORK: � ' Z�� �}/4 G�i jr - Z1�/
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<br /> . .. ,•:=:::. .CONTA�T INFORMAfi�ON, .:�:.�. .' .,.. ��. �: `.. , . .
<br /> OWN�R NAME: l' • TENANT NAME N`Commerclaf :
<br /> QWNER MAILING ADDRESS: srneeT '' •
<br /> 0�1Y STATE 21P �V ZV.J
<br /> OWNER PHONE: OWNER EMAIl.:
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<br /> CONTRACTOR MAME: • .G� QG �''� ,�(',,
<br /> CONTRACTOR ADDRES3: STREE7 �
<br /> CRY ""G� BTATE � LP �
<br /> CONTRACTOR PHQNE: Z��'g 7�.' � CONTRACTOR EMAI�: �• ,
<br /> COTITRACTOR UC. RERUIRED):c, ���� ��J{/ CITY OF EVERE7T BUSINESS LIC.#RSQUIf2El7): �
<br /> PRIMARY CONTACT: 0 OWIVER ONTRAGTOR �❑OTNER{Please Speclfy}
<br /> C NTACT NAM�: / CONTACT PHONE: �3• � . �7�
<br /> Ir_J�I/G�RIY1 L���I Z. CONTACT EMAIL; �. � (�? ��' � ,�
<br /> AGREEMEIVT.•t hereby certlfy that!have read a»d examined this applicaBon end know the same to ba true and carrecf. Al!provls/ons oflaws and arcfinances govemrng this fype
<br /> of wwk wi!!be completed whether speclifed hareln or not, The g�n►rting of a psrmlf doss not presume to glve aelthority fo vlotate or cansa!the provisiar�s of any other state ar
<br /> Jocallawregalaftng cvnstrucNon or the perlormense o/construction. That!am autharized by the awnai of thls proper[y fo pertorm the work for whlch appllc�tton!s made and 1
<br /> comply wlth the State Contracfors Law 98,27 RCW and 296.200 WAC.
<br /> Clty of Everett O�c/al Use Onty
<br /> ���_ . f PERMIT# ' ���
<br /> ��.; �w�� � �.�:s r� E�� I l
<br /> Owner/Authorized Agent Slgnafure Date (Revlsed 8/23/2016J
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