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OOP 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 I (E) everetteps@everettwa.gov I www.everettwa.gov/permits
<br /> n^a i� it� e � x � �, ? � i�`-�a �� 't,r � *� t� �' � �.;
<br /> y �} 1 c` $�\ e .` 4 C IpIiI QJ :1£rl 'II,.. .IIA T40��• ...,a .,� ..�. °r��\ �-1�. �.r g v e �;,eve
<br /> t�.i..1 t_� �, _.�>�. .,�.. J74?
<br /> . " "„, � �PROJECT ADDRESS:Z,o(o g �(,Q„p. Q.e, RQaL t ote.,0,1, ( A �<11.,03
<br /> BUILDING AREA(if residential,new construction,remodel,or addition)itSF
<br /> BUILDING TYPE: 0 SFR-DETACHED ❑. SCFR-ATTACHED lsr DUPLEX 0 MULTI-FAMILY-#OF UNITS: 0 COMMERCIAL
<br /> USE OF BUILDING: j ..�
<br /> .* ,y � �`��t lY� > r. t�, R ;£ 5 v T+� y +S .* z.f .x. l x� ice!
<br /> s,7 ,q�Er�+ Ia1rt A,,.„,41 ' Y '� I M��t ►' + i�, 6„r . ..�A'Ato, ^r.,% ::,: s s.•
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<br /> CONTRACT PRICE OF WORK:$ a- O ---_)
<br /> NUMBER OF DEVICES (if low voltage):�/
<br /> FIRE ALARM? 0 YES CI NO A... c'l{ s 4->
<br /> ASSOCIATED BUILDING PERMIT#(if applicable):
<br /> DESCRIPTION OF WORK: (O scovw .f A r is++ve... 46, a 6.0%em s--c I .4..n+(o.. IA r'>r. b•x
<br /> pAdA. Vz) 3on►•tP 61.4440,.- DZSCA9 me icer P14464- Pte'”`'� + 3t� hitt" toes, a�t r is re(,y.44, kx }
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<br /> � v>e�er:c{res 044- brcal�,e•-s ;► rll•.tal.d,1►e_ box !ap
<br /> r Hak► a404(3) ►►vs d b+. �^s:Cad tolkSbia - CII Mw'. - fette'lfiade.
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<br /> CONTACT 1N .ORMATION+1 .:
<br /> OWNER NAME:'1 L e.( M ib TENANT NAME(If Commercial):
<br /> OWNER MAILING ADDRESS: *STREET 1.64.41.44e t
<br /> CITY y STATE 0IZIP 90040
<br /> OWNER PHONE:Z. � pJOWNEREMAIL :0
<br /> / f Q
<br /> 4.00,1
<br /> CONTRACTOR NAME: ' 1:641,44,.,.
<br /> CONTRACTOR ADDRESS: STREET
<br /> CITY STATE ZIP
<br /> CONTRACTOR PHONE: (CONTRACTOR EMAIL:
<br /> CONTRACTOR LIC.#(REQUIRED): CITY OF EVERETT BUSINESS LIC.#(REQUIRED):
<br /> PRIMARY CONTACT: 17, OWNER 0 CONTRACTOR 0 OTHER(Please Specify)
<br /> CONTACT NAME: CONTACT PHONE:
<br /> CONTACT EMAIL:
<br /> AGREEMENT:I 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 I
<br /> comply with the State Contractors Law 18.27 RCW and 296.200 WAC.
<br /> City of Everett Official Use Only
<br /> PERMIT#
<br /> ALJ)4. ?n ,,,,1.b io 2.3: er E V s ,\C)-20(o
<br /> Owner/Authorized Agent Signature ! Da (Revised 9/23/2016)
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