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ELECTRICAL PERMIT APPLiCA�ION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT,WA 98201 <br /> (P) 425-257-8810 � FAX 425-257-8657 � (E) everetteps@everettwa.gov � www.everetlwa.gov/permits <br /> _ `_��a�i��;�r�.���r�a�N��ai���TXcs� <br /> PROJECT AQDRESS: � ' � � <br /> Bt11LDiNG AREA;{�f resldentlal, new constructlon,remodel,or addlti�n} �� <br /> BUtLL�ING TYPE: SFR-DETACHED � SFR-ATTACHED ❑DUPLEX ❑MULTI-FAMILY-#OF UNITSc ❑ COMMERGIAL <br /> t15�OF BUILDING. � <br /> ' EL�C't"�l�A�.`�l�!�?�.��t�Ti�f�1��1���33t�tN1,��"�+t'�hT <br /> CONTRACT PRICE OF WORK: $ � .� <br /> NUMBER OF DEVICES (if low volta e : <br /> FIRE ALARM? ❑YES NO <br /> AS50CIATED BUILDING PERMIT# if a licable � <br /> _ .T�S.�t�lP�1'lfJ.I�t C�.F.,'�t.QRK:....__ , ���r,,_...... . <br /> ` �+�f��'"��1�,��' t�,�,�t�itl���C��1�+1 <br /> 4WNER NAME: TENANT NAM� (f Cammercia) ; <br /> OWNER MAfLING ADDRESS: srReEr ��"' r+ <br /> cirr 3TATE C�+ R��C,� <br /> ZIP <br /> �WNER PHONE: OWNER EMAfL; <br /> , <br /> CDNTFtAGT{7Ft NAME: �� . <br /> CONTRACTORADDRESS: �TREEr � � ��� <br /> ciTv srn� �- zia � �(� <br /> CONT'RACTOR PHONE; � �j � CONTRACTOR EIVIAIL; � <br /> _ , � f�N <br /> _._. <br /> C'i3N"f'Ft.A�I'CJT�'�T�x,�(FtECaUEi�Eci):�YYt��; <br /> _..... <br /> � � .. ___.._...� <br /> _... ... �—�,. --- _._..._— _____._ _.. <br /> jt. �,— Gf�'`l t7F EY�RETT'�tlwIIVESS LIC.#REC2UfREt7: <br /> PRIMARY CONTAC7: ❑OWNER CONTRACTOR CI OTHER(Please Specfiy) <br /> ��JNTACT NAME: GtJNI"ACT PHONE: �r� ��(,� �tf�` .._.. <br /> � "����c.t�1C��e CONTACT EMAIL, �� '�� I„�,� ,CQa� <br /> AGREEMENT.•!hereby certlfy(hat f have reed and exemined!hls appliceUon and know fhe seme fo be true end conect. All prov►91on5 o/laws end ordinances govemtng Ihis lype <br /> of work wil!ba comp/efed whe(her specl�ed hereln or nof. The granf(ng of a permlf does nof presume to glve eutho�i(y to vlolate or canse�lhe pivvlsfons of any ofher sfate or <br /> Jocal law regulaUng consfrucllan or lhe performance ol consbuction. Thaf 1 em aufhor/zed 6y Ihe owner o!lhls property fo perform the work for whlch appNcatlon is made and I <br /> comply wlfh!he Stete Controcfors Law 18.27 RCW and 296.200 WAC. <br /> C!(y o/Everett Olilcla!Use Only <br /> —.—�..�.�.�.... <br /> PERMIT# <br /> ��� � <br /> �_._. ,��.�.��__�_.._�:�..�"�____ E 1 �-� � (���� <br /> OwnerlAuthartxect Agent Stgnature <br /> Oate (Revlsed 9/23/2016J <br />