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12/01/2016 16 : 43 #1375 P. 001I001
<br /> ELEC'TRICAL PERMIT APPLICATION
<br /> CITY OF EVER�77 P�RMIT SERVIC�S
<br /> 3200 CEpAR S7R��T, �V�R�I"7, WA 98201
<br /> (P)425-257-8810 1 FAX 425-257-8857 � (E) everetteps cGDeverettwa.gov � www.everettwa,gov/permits
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<br /> PRO,�ECT ADDR�SS: G—
<br /> �UI�DING AR�A(if residential, new construetion, remodel, or addition) S�
<br /> �UI�piNG TYPE: Q 5FR-DETACH�p ❑ SFR-ATTACH�D O DUPL�X ❑ MU�T1-FAMILY-�OF UN17S;,,,� ❑COMM�RCIAI.
<br /> USE OF HUiI.DING:
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<br /> CONTRACT PRIC�QF IMORK:$
<br /> NUMB�R OF D�VICES if law volta e :
<br /> FIR�AL.ARM? Ca Y�S CI NO
<br /> ASSOCIATER sUILDING P�RMIT# if a Ilcable :,
<br /> p�SCR1PTION OF WORK: `I1�� �
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<br /> „!�!kT�! '�?�' �� ��T!�A 5�7,� ,�r.v���
<br /> OWN�R NAME: p l r .(.. TENANT NAI�� If Commerciaf :
<br /> flWN�R MAILINCy ADDRESS. srReer �j D ��, �
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<br /> OWNER PHQN�: D OWN�R�MAI�:
<br /> CONTRACTOR NAIIME: /.- �lk �l1 � �
<br /> CONTRACTOR A�pR�SS: srRe�r
<br /> � CITY ' STATE ZIP
<br /> CONTRAC70R PHON�' Y�f � .Z� � CONTRACYOR EMAIL:
<br /> COHTRACT�R�IC.�f REQUIR�Q)= I- L`�'�.�Jf CITY�F�VERETT SUSIN�SS�IC.�F RECIUIR�A)= �l ��P
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<br /> PRIM,4RY CONTACT: ❑OWN�R ❑COIVTRAGTOR 0 07HER(Please Specify)
<br /> CONTACT NAME: CONTACT PHON�: y L f �� /
<br /> C OIZ/l( fGL—Lt� CON7AC7�MAII.:
<br /> AGREFM�N7`T hereby oertify tpat I have�ad and examrnetl thls application and know the same to De true and conect. AU provls/ons ol laws and ord�nancos govern/nq 1hls
<br /> typ�of work w/ll be completsd whetnar specrfied herein or no[ 7Ae granting of a pe/mit e'oes nol presume to Biva authority to v/olate or cancal tha provisrons of any oiher stata or
<br /> loca!law regu/atrng constaction or the parfarmance of construetlon, That I am authorlred ey the owner of this propBrty to perlorm the xrork/oi whrcn appl;catlon is made and!
<br /> eomply with the Stat�ConG�etars Law 18,27 RCy1/and 298,20o WlIC,
<br /> City of�'verett Offrcial Use onfy
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<br /> P�RMl7#
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<br /> ownor/ rized A9ent signature p (Revised 10/97J20�5)
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