|
ELECTRICALPERMIT APPLICATION
<br /> CITY OF EERTT PERMIT SERVICES
<br /> 3200 CEDAR STREET, ET `, WA 98201
<br /> (P)425-257-8811 I FAX 425-257-8857 (E)everette @eve :gov 1 www,everettvvagovfpernlits
<br /> .1111.,.
<br /> PROJECT SITE INFORMATION
<br /> 'PROJECT ADDRESS: " i' '°I l et at „, r ,. ir
<br /> . .
<br /> ............,_
<br /> BUILDING AREA(if residential, new constructs.• remodel,or addition) SF
<br /> BUILDING TYPE. 0 SFR-DETACHED 0 SFR-A i I ACHED 'ADUPLEX 0 MULTI-FAMILY-#OF UNITS. 0 COMMERCIAL
<br /> USE OF BUILDING: 1 d ^
<br /> 411011101111.11111101..
<br /> _1101...
<br /> ELECTRICAL APPLICATION INFORMATION
<br /> .
<br /> CONTRACT PRICE OF WORK:$ 3-op
<br /> NUMBER OF DEVICES cif low volta.e R
<br /> PRE ALARM? 'I YES NO
<br /> ASSOCIATED BUILDING PERMIT# if a..licable : I ,
<br /> DESCRIPTION OF WORK: 11 ,, I . 4 _ ,..:' .F ++1A 1 '. ' : ' IIIIIII
<br /> / --c - , p ii / c ,, / t f / . , z = �
<br /> ' ✓ +! 4 0 2.r s ,
<br /> V
<br /> CONTACT INFORMATION ...';' �..< .
<br /> _1111 .
<br /> OWNER NAME: I` .i r yytI) TENANT NAME(If Commercial}:
<br /> .OWNER MAILING .DRESS: STREET
<br /> 1111.
<br /> CITY 1111'1111. STATE ,1111
<br /> OWNER PHONE: U i, } OWNER EMAIL:
<br /> CONTRACTOR NAME: , / ,e' .e 1 ” /A ) - 1 ,
<br /> 7
<br /> CONTRACTOR ADDRESS: s,r wev /!',/`QO2. -2.,,,b/1,--, )
<br /> -,
<br /> CONTRACTOR PkIONE: 6 ` 3.0,-7t5 CONTRACTOR EMAIL: a a• .r AL. 'Q' ,.K. jai,,l' 't.9 ,4:-,7
<br /> 4CONTRACTOR LIC.#(REQUIRED): CITY O EVEREiT BU = ESS LIG,#(REQUIRED):
<br /> `PRIMARY CONTACT; ®OWNER CONTRACTOR 0 OTHER(PleaseS•.':
<br /> CONTACT NAME:
<br /> CONTACT PHONE:
<br /> CONTACT EMAIL; ,'
<br /> EMAIL; - .dy ai ce\ b.'
<br /> A ptE` mE T I hefed ya certify 81w d halm a�iaxarrairaed thus agodioatlon and know the sable to be true and erect. All provisions of tonus arm rr°�{traarrs
<br /> of work mil c complod J vkaatt or ap ffi•Sgt, , Ur rant. me gran o nq of a pen ww does net preaurne to P ,,_ :to Wolate or danced the -
<br /> lr f lase regulating iPleiodaaolkan the y . t srr trtantroa T ai d am aarthorgad b Ole o air Baro oras of any.
<br /> y s x;as week r} K i riffs ,r
<br /> comply Atha the.Made rraaract srs Law 18„27 i ;Wend 298,200 W
<br /> City cat Everett Official Use only
<br /> ,J //2,,,,,,,b 1111 g
<br /> ,,, 1111. #/ Lf� ,,.. '” '1„,,,,,,,,,
<br /> r
<br /> Owner/ thorixed Agent Signature Date )(Revised 9/2,112016)
<br /> i
<br /> I
<br />
|