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�-� ELECTRICAL PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT,WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 1 (E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> PROJECT ADDRESS; , <br /> BUILDING,AREA(If residential,new construction,remodel,or addition.) SF <br /> BUILDING TYPE SFR-DETACHED 0 SFR-ATTACHED 0 DUPLEX 0 MULTI-FAMILY-#OF UNITS: 0 COMMERCIAL, <br /> USE OF BUILDI G: <br /> 14 <br /> c..., _..` z.Yriw.wrwrrrrwwu,. .r.�,�,w <br /> CONTRACT PRICE OF WORK.$ . .+t cc. ... <br /> NUMBER OF DEVICES Of low voltage); <br /> FIRE ALARM? ❑YE...$ I�_NO <br /> ASSOCIATED BUILDING PERMIT#(if S p11cab1e) <br /> DESCRIPTION OF WORK: �� ++ <br /> 3 =, <br /> OWNER NAME TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: <br /> crrY: ., SI •. <br /> OWNER PI IONS: tlrl.t :. ., OWNER EMAIL: <br /> ... . s <br /> CONTRACTOR NAME:; A` <br /> r <br /> CONTRACTOR ADDRESS. STREET •.'; •`, <br /> nY, awl $7A79 a A ZIP< 20 <br /> CONTRACTOR PHONE. 9$(;73 : CONTRACTOR EMAIk„i:: .'. 1 e..,,:. { 1 .9 r _._ryi <br /> CONTRACTOR LIC-#(REOUIRSpt C (j fld et CITY OF EVERETT BUSINESS LIC #(REOUIREC}. <br /> PRIMARY CONTACT: 0 OWNER 'a CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: is ACT PHONE q <br /> le CONTACT EMAIL `1: C0 <br /> AGREEMENT,. hereby certify that i have read and examined this application and know the same to be true and correct. All provisions of laws and ordinances governing this type <br /> of work will be completed whether specified herein or not. The granting of a permit does not presume to give authority to violate or cancel the provisions of any other state or <br /> local law regulating construction or the performance of construction. That I am authorized by the owner of this property to perform the work for which application is made and t <br /> comply with the State Contractors Law 18.27 RCW and 296.200 WAC. <br /> City of Everett Official Use Only <br /> PERMIT# <br /> 12.12 .1 <br /> DWoorfAutnortzeti Agent Signature, Date (Revised 9/23/2016) <br />