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ELECTRICAL PERMIT APPLICATiON <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 962p1 <br /> (P)425-257-8810 � FAX G25-257-8857 � (E)everetteps@everettwa.gov� www.everettwa.gov/permits <br /> I�I��J�C'T��SM'��%K�±IFt�RM�T.1t�N <br /> PROJECT ADDRESS:,,�J�� ���J�Hx' � �� <br /> BUILDING AREq(if residentlal, new constructlon,remodel,or addition� SF <br /> BUILDING TYPE: SFR-DETACNED ❑SFR-ATTACHED ❑DUPLEX ❑MULTI-FAMILY-#OF UNITS: ❑ COMMERCIAL <br /> US�OF BUILDING: <br /> ., . ,;. :. �,-: . -,, .� <br /> ���c��a�caL�ia�+��»i�A'rtr�Nr���t��►�t�,����M <br /> CONTRACT PRICE OF WORK: $ („� � <br /> NUMBER OF DEVICES if low volta e ; <br /> FIRE ALARM? ❑YE5 �� <br /> ASSOCIATED BUILDING PERMIT# i`a licable : <br /> �. __L?E�.�RiPIIG?.t�LSa,��4t.QL�K: ___ �.� �^ <br /> ' � : f�t���'Ai�°I"1��k1F�lVfri�i����i , , , <br /> OWNER NAME; TENANT NAME 1f Coinmerciaf : <br /> C?WM1fEF� MAILING ADDRESS: sraeer � � ,� T*°� �� <br /> Cf1Y � �/1 <br /> 3TATE y�p +(�'{/ <br /> 4WNER PHONE: � OWNER EMAIL: <br /> CONTRACTOit NAME: '� � <br /> CQN7FEAGTi]R qDDRESS: sTrxEer ' � �O� <br /> (:ET'Y � $TRFF �- <br /> 7�s �j 2v <br /> CONTRqGTpFi pHONE: `�}" ��-j CONTRACTOR EMA(1�: � <br /> _ , ��NTF�IXG`T�R'CTC;REQUIR�Cx)t�Y}�� • r N1/! <br /> Ca"CY OF EV�RETT BUSINESS LIC.#REQUiREDy �� <br /> —�- �—�.�,,_� _ _ <br /> PR(MARY CONTACT: ❑OWNER CONTRACTOR ❑OTHER(Pfease Specify) <br /> CONTACT NAME: CC�NT,RCT PHONE; �� '��G� ��� <br /> � `E����Cr GONTACT EMAIL: � �� ��� �� <br /> AGREEMENT.•!hereby cerfity fhat i'heve read and exemined fhls applicetfon and know Ihe seme fo be frue and correct. All provlsfons o/laws and ord(nences goveming ihrs type <br /> ot work wl71 be completad whefher spec/fred herein or nof. The granOng o1 a permif does nof presume fo glve euthonly fo vlolafe ar cancef!he provlslons oJ any ofher sfafe or <br /> local law regulaUng conslrucfion or(he peAarnance o/consfruclion. That!am aufhoHzed by Ihe ownar o(Ihls property fo perform fhe work(or whlch appllcailon is mede end I <br /> comply wlfh tha State Contractars Law 18.y7 RCW and 296.200 WAC. <br /> Clry a1 Everett O�cfel Use Onty <br /> PERMIT# � <br /> �--- ' �k`�..���� ��ZS��� E �,� - �� � <br /> ownerlAuthvrized Agent Stgna(urQ �' '�"""�— <br /> �ale <br /> (Revlsed 9/23/2016J <br />