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ELECTRICAL PERMIT APPLtCAT10N <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.gvv � wvvw.everettwa,gov/permits <br /> i�ROJEGT 31T.�;INFt�RMh71tli�i <br /> PROJECT ADDRESS: �7(p �,}�°�,� �'' <br /> SUILDiNG AREA(if residential, new construction,remodel,or addifionj SF <br /> BUILDING TYPE: SFR-DETACHED ❑SFR-ATTACHEQ ❑ DUPLEX ❑ MULT!-FAMILY-#OF Ut�(TS; ❑ COMMERCIAL <br /> USE OF BUILDING: <br /> ELEC`t"RICA�.QPPl.IC�7'tt'3N'IN�'.t'ft�MA,�'ION <br /> CONTRACT PRICE OF WORK: $ {,^� ,� <br /> NUMBER OF DEVICES if low vofta e : <br /> FIRE ALARM? ❑YES NO <br /> AS50C(ATED BUILDING PERMIT#{if a Iicabie : <br /> D�SCl�iP7"ION {7�VY�RKs �"'Yl.i("„�."�t�,',, <br /> C+�NThCT IN�CIF��A'f'M�f�l <br /> OWNER NAME: �*�,,1 � (�,�+'1 � TENANT NAME(If Commarcla(: <br /> OWNER MAIUNG ADDRESS: sraeETZ(p�7 (,,G,r(lv� f�i" <br /> Cf1Y �, t✓f��,�+ STATE �IT' .... LIP 1 U�O� <br /> OWNER PHONE � ( 2,` d ?O gy�.. OWNER EMAIL: <br /> CONTRACTOR NAME: ��f <br /> CONTRACTORADDRESS; srReEr ` , ��C� <br /> CiTr 97ATf � 21P � �V <br /> Ct1NTRACTOR PHONE: �� CONTRACTOR EMAIL: � ' � y'N <br /> _ __._. <br /> _. - -_... <br /> G(}WTRACTOR�1C:�(REt1UIRE0j:C�Y��G'. �� �(,�f1 CI'TY'OF EVERETT BUSINES5 UC.#�REQUIRED); <br /> PRIMARY CONTACT: ❑OWNER CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CpNTACT PHONE: �r".U, ��G� ��� <br /> � '�y�Ie CONTACT EMAIL: C�!� �A� �1� •C�YY3 <br /> AGREEMENT:!hereby certity lhat t have read and examined fhls epplication and know the sema to be frue end conect. All provlslons of faws and ordinances goveming this lype <br /> of work w!N be complefed whether speclfted hereln or not. The granfing o/a permlf does not presume to glve aufhorlly fo v/olate or cencel the provlslons ol any other sfate or <br /> local!aw regulaNrtg construclfon or the performence o/construcfron. Tha!1 am aufhonzed 6ylhe ovmer of(hls properly fo pertorm fhe work for whlch appflcetlon is made and f <br /> comply wlth!ha State Contractors Law 18.27 RCW and 296.200 WAC. <br /> Ciry of Everett Officla!Use Only <br /> PERMIT# <br /> �`Q-1��2� �Q.l,t..PJ� � I 2•� • 1`� E � � �2 - �J <br /> '— i-r�----• -c �-----,-�..�_._...._�� � <br /> OwflertAuthartzed Agent Si�neture Oate (Revised 9/23/2016) <br />