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!o. t9 <br /> ,00400, <br /> ELECTRICAL PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT,WA 98201 <br /> (P) 425-257-8810 ) FAX 425-257-8957 I (E)everetteps@everettwa.gov( Www.everettwa.govfpermits <br /> tAtt '• <br /> PROJECT ADDRESS,. ► <br /> .e . , <br /> BUILDING Aif REA • res d nt[e' new�, � .�ns,r,a„tton remodel,or addition) BF <br /> BUILDING TYPE: i ar-R-DETACHED Q S R-ATTACHED 0[DUPLEX 0 MULTI-FAMILY- <br /> 4 <br /> lk OF UNITS' 0 CC7ibfiVlcitCf:l <br /> USE OF BUILDING: • <br /> " Cmay: +yypyQjj x6gym j <br /> CONTRACT PRICE OF WORK: $ 0 «' <br /> NUMBER OF DEVICES if low voltage; <br /> FIRE ALARM? Q <br /> YES C3 No <br /> ASSOCIATED BUILDING PERMIT# I" dtoable: <br /> ADERC; - v*, * . .Lit .- <br /> Vi ., , & * INA <br /> _ tr <br /> OWNER NAME. • <br /> 0 a TENANT NAME. f;.Dommeralal.; <br /> OWNER MAILING ADDRESS: 3TREEr $ f., ° <br /> • <br /> ..ay, .4. ...d�...mt ji! STATEAi ZIP . <br /> O IsikR PHONE " N417 ,a► <br /> " OWNER EMAIL: <br /> CONTRACTOR NAME: r <br /> CONTRACTOR ADDRESS: <br /> srrrE ZIP 98 2o <br /> CONTRACTOR PHONE: <br /> 4 e • CONTRACTOR EMAIL: <br /> ••' Ea C •OF EVERETT BUSINESLIC.#REQUIRED): d <br /> PRIMARY CONTACT: C7 OWNER tgr CONTRACTOR Q:OTHER(Please Specify) <br /> CONTACT NAME: <br /> 'CONTACT PHONE <br /> CONTACT EMAIL. iftetxt-1 .CEJ <br /> AGREEMENT:1 hereby certify that have read and examined this application and know the same to be true and Correct, Ali provisions otlaws and ordinances governingthis type <br /> of work will be completed whether specified here/n 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! <br /> comply with the State Contractors Law 18.27 RCW and 296.200 WAC. <br /> City of Everett Official Use Only <br /> IPERMIT <br /> # <br /> . t o• _pc) E k i6C)— C 2_Co <br /> OwnetlAttliteits,tid Agent Signature <br /> Date <br /> (Revised 9/23/2016) <br />