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ELECTRICAL PERMIT APPLICATION <br /> 011/-N17-":"":"Ai- <br /> PPLICATI , <br /> A CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 J FAX 425-257-8857 I(E)everetteps everett*a:gov t Www.everettwa,tgov/permits <br /> PROJECT ADDRESS: � ,, .,..._.. � . .. <br /> RESS: <br /> BUILDING AREA(if tesklerntiai,new construction,remodel,or addition) SF <br /> BUILDINS TYPE: 0 SFR—DETACHED '0 SFR-ATTACHED 0 DUPLEX 0 MULTI-FiAMiLY-#OF UNITS: COMMERCIAL <br /> USE OF BUILDING.; <br /> . ����(r y 1 <br /> y� y`{� ,■,(yy■■ ■1�/■■a�tev■■ <br /> R' b <br /> CONTRACT PRICE OF WORK:$ ` - C <br /> NUMBER OF DEVICES(If low voltage): <br /> -FIRE ALARM? 0,XCES 0 NO <br /> ASSOCIATED BUILDING PERMIT-#(If applicable): <br /> DESCRIPTION OF WORK: 410,a-3772//f-14 "n '5 017 <br /> e77 :.4..,.I <br /> OWNER NAME: TENANT NAME(if ComtnerOtal): ;''< <br /> °NNE.R MAIL.INGADDRESS STREET # rig f or <br /> 6,„ �' STATE ,g 41A- <br /> ztp- <br /> OWNER PHONE; - '5o ' OWNER EMAIL: (3:&. <br /> CONTRACTOR NAME; ~; m , . 4 __ t; CLT I�SLQ�1 �C <br /> 0 <br /> CONTRACTOR ADDRESS: arm I • <br /> ... - - errV .:40"'4‘ -: r *-. STATE zip 9.o <br /> CONTRACTOR PHONE; CONTRACTOR EMAIL.; <br /> CONTRACTOR LIC ii(REQUiREDit CeCe YlitA44a CITY OF EVERETT BUSINESS LIG,#(R 1RED): <br /> H Please S <br /> IPRIMhRY ClNT,�CT; ■.OWNER' ClNT�GTlR ■OTHER Specify), <br /> CONTACT NAME• CONTACT PHONE: - <br /> CONTACT EMAIL: <br /> AGREEMENT Chereby ertllytbet i have read and e0mined this epploat&rrr and know thename tobe true andacoirect A/i�s of laws and ordinances governing this boo <br /> await will be completed whether specified,',attain or not The grant:agate perrrrY ea s nvt preemie le !e attfhorl&tevidate eray:eel the preyisions sdany-other:state of <br /> local law regulating co struction or the petfoenence of conattstat}'arr. That I am.au ho,ized by the awnerofthls property to perform the:wottcfor svhinh appt alion is made.end I <br /> rrxplywFttr.the Slate Contractors Leu1 10.2TROWand296200 HOC, {' <br /> City of Everett Official Use Only <br /> PERMIT#` <br /> ")14itE \q01 - 0c 2 <br /> © !Authorized Agent Stgnature Date,.: (Revised 9/2312D16) <br />