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ELECTRICAL PERMIT APPLICATIO
<br /> CITY OF EVERETT PERMIT SERVICES � ORIGINAL
<br /> 3200 CEDAR STREET, EVERETT, WA 98201
<br /> (P) 425-257-8810 � FAX 425-257-8857 � (E) everetteps@everettwa.gov � www.everettwa.gov/permits
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<br /> se. s �- �_ � � . � � � � � f
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<br /> PROJECT ADDRESS:���3
<br /> BUILDING AREA(if residential,new construction,remodel,or addition) , � � SF
<br /> BUILDING TYPE: SFR-DETACHED ❑SFR-ATTACHED ❑ DUPLEX ❑ MULTI-FAMILY-#OF UNITS: ❑COMMERCIAL
<br /> USE OF BUILDING:
<br /> �{ i.��R�6��' d`�!�� ,� Pi�.rN •� � � �i a . u q 4) 8 ,��r "� `� 4 IiN° �"
<br /> ���-il �� �� �` E'� 1'���AI�P 1�1F4RMA'G� '�' ��r���������� ���; �!h �
<br /> �����<�.;������ "�� ���. ��' �. :�`�� �' ' ������ k,�» ;�� a«.
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<br /> CONTRACT PRICE OF WORK:$ Q
<br /> NUMBER OF DEVICES if low volta e :
<br /> FIRE ALARM? ❑YES ❑NO
<br /> ASSOCIATED BUILDING PERMIT# if a licable :
<br /> � � �
<br /> DESCRIPTION OF WORK:
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<br /> I���� i 2r7i ..I„��t�4��IIIHi� -�.I������h��li,����i',"ry��`M�� u,-�,_) �(=..�„�i �� �,rl�., n i: v � ,�tFo,, ��G1IUI���I��p,i � .�..a . UI i � �`lw�,i°:r•� ����•r�im��::� ,F��m�.
<br /> "�r4"� .._:i I� �.�M�y a�h i I��:,;�itla a.. ') ��': ��'' � '�T�� .. ��T��� �,..tl� � ,..,I ikPii;YE�, �I { i�� �,i„ r'�+� r�a� �^, �� .��ar,°:!.
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<br /> , , ._...,5���a_6�,.hnatl �iiila�...�,��..,� 3h�`.�.�.m�, r�. �..a.� NIIII� ��!I,em�:�wmiiuN�mi� .� ...wo-m.i�01�m..�asaiaiiiiliillim�itia�.�'�'�!,�F���... .�n�'cA�HI� ��..I���i�u,�r,���i-0ad �,� ��.,r�ei�II�I1�a i..16�.i.�..;n�r�.
<br /> OWNER NAME: TENANT NAME(If Commercial):
<br /> OWNER MAILING ADDRESS: srReeT �l�Z � L%
<br /> CITY STATE� ZI
<br /> OWNER PHONE: 1' (/✓v OWNER EMAIL:
<br /> CONTRACTOR NAME:
<br /> CONTRACTOR ADDRESS: STREET � T' �
<br /> CITY STATE ZIP
<br /> CONTRACTOR PHONE: L �J '�� " CONTRACTOR EMAIL: Q
<br /> CONTRACTOR LIC.#(REQUIRED): �U� CITY OF EVERETt'BUSINESS LIC.#(REQUIRED): `Z�
<br /> PRIMARY CONTACT:� ❑OWNER � �NTRACTOR ❑OTHER(Please Specify)� �� ���� ���-�� - ����� �� ������� �-��������
<br /> CO T CT NAME: CONTACT PHONE: L Z — � —
<br /> � � CONTACT EMAIL:
<br /> AGREEMENT.•T hereby certi/y that I e read a examined this application and know the same to be true and correct. All provisions of laws and ordinances goveming this
<br /> type of work will be completed whether specffied herein or not. The granting of a permit does not presume to give authoiity to violate or cancel the provisions of any other state or
<br /> local law regulating constNction or the performance of construction. That/am authorized by the owner of this property to perform the work for which application is made and 1
<br /> comply with the State Contractors Law 18.27 RCW and 296.200 WAC.
<br /> City of Everett Official Use On/y
<br /> FEE
<br /> �-s -
<br /> PERMIT#
<br /> - � ��' E ��0�- Z���
<br /> O n /A n Signature Date � (Revised i0/12/2015)
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