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ELECTRICAL PERMIT APPLICAT(ON <br /> CITY OF EVERETT PERMIT SERV{CES <br /> 3200 CEDAR STREET, EVERETT,WA 98201 <br /> (P}425-257-8810 � FAX 425-257-6857 � (E)everetteps@everettwa.gov� www.everettwa.gov/permits <br /> PrRC�J�,CT'S�IT�INFURMATION <br /> ,_, <br /> Pf�OJECT ADDRESS: �{p�O �'�r�, ��"'� W I O <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 BU{LDING: <br /> ELECTRlCAL.�APPLIC�!'t'ION61N�01'�M/ltit`?N <br /> CONTRACT PRICE OF WORK: $ � ,°'� <br /> NUMBER OF DEVICES if fow volta e : <br /> FIRE ALARM't �YES [7 NO <br /> AS50CIATED BUILDING PERMIT# if a iicable : <br /> D�3GR1PTtQC�t QF{ltitQRK: __ _._ _ W _ Ir'11\.a��. '�'�"' !'�,. <br /> ::CC)l�TA�GT IN�C�Rt�A`Tlt��l <br /> C?WNER NAME: �"" [) TENANT T�AME If Commerclaly: <br /> DWNER MAILING ADDRESS: srrtEET Q Z S S � 'rt— W IO <br /> cro srnrE W zra [,..?p�� <br /> OWNER PHONE: f(Q OWNER EMAIL: <br /> CONTRACTOR NAME: � <br /> CONTRACT�RADDRESS; srReEr � � �p� <br /> CITY - STATE ..� ZIP � GV � <br /> CQNTRACTOR PHONE: �C( GQN7RAGTOR EMAIL: + yy► <br /> --..__..._._�._ _._._.. - --_ __ <br /> _,_—_-_ __ <br /> GONTf:�i�'��f�Ll�:#(REQUIRED);C���. � �(��'l CITY OF EVERETT BUSINE55 LIC,#(REQUIRED): <br /> PRIMARY CONTACT: ❑OWNER CONTRACTOR ❑OTHER(Please Spedfy) <br /> CONTACT NAME: COhlTAG't PHONE: �� a�Gt �� <br /> J �Ie CONTACTEMAIL: GI ' [• �'C�CI' COY� <br /> AGREEMENT:1 hereby certily that l have read end exemined fhis applice(Iorr and know the same fo be true end correcG All provislons oflaws end ordinances goveming fhis type <br /> ol worN wlll be compteted whefhe�specified hereln or noL The granfing of a permtf does nof presume to glve euiharity fo vlolate or cancei the provls/ons of any other sfafe or <br /> loca!!aw regulaling construcflon or fhe perJormance o/conslruclion. Thaf I am aufhodzed by fhe owner o1 fhls property to peHorm(he wark for whlch appflcallon is made and 1 <br /> comply with fhe 5fate Contracfors Law 18.27 RCW and 296.200 WAC. <br /> Clty of Everett O�clal Use Only <br /> PERMIT# <br /> � <br /> ���� c�..e� _ _ i � � �3. i� E 1�-<< -- b�l � <br /> Owner/Auihorized Agent Signature � Date (Revlsed 9/23/2016) <br />