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ELECTRICAL PERMIT AP LICATION
<br /> Nitiogii 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
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<br /> PROJECT ADDRESS: (D-CM (Fn ,,j\< ci('.k R-Q,
<br /> BUILDING AREA(if residential, new construction, remodel,or addition) SF
<br /> BUILDING TYPE: 0 SFR-DETACHED 0 SFR-ATTACHED 0 DUPLEX 0 MULTI-FAMILY-#OF UNITS: 0 COMMERCIAL
<br /> USE OF BUILDING: ' w c3
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<br /> CONTRACT PRICE OF WORK:$ %C.rc , c-0
<br /> NUMBER OF DEVICES (if low voltage):
<br /> FIRE ALARM? 0 YES 0 NO
<br /> ASSOCIATED BUILDING PERMIT#(if applicable): 1
<br /> DESCRIPTION OF WORK: e c.`,I C �`T -Pv— Vu? L. I 0 CA,-4- Pvt v4-1 0
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<br /> CONTACT INFORMATIO i
<br /> OWNER NAME: TENANT NAME(If Commercial):
<br /> OWNER MAILING ADDRESS: STREET
<br /> CITY STATE ZIP
<br /> OWNER PHONE: OWNER EMAIL:
<br /> CONTRACTOR NAME: GeN(1) S/�' !;/,r-e-lizr` 1 �-C L
<br /> TACONTRACTOR ADDRESS: STREET � ?c J r1" ,
<br /> CITY r-(t../ Lt( STATE 1,l4 ZIP � ' 7 f
<br /> CONTRACTOR PHONE: I.0 /' —$73% CONTRACTOR EMAIL: `: C.-Iq c1 S ,SQ ejcsi (Z. Q L(iik. * Ccli'.-1
<br /> CONTRACTOR LIC.#(REQUIRED): , `la _ CITY OF EVERETT BUSINESS LIC.#(REQUIRED) 1 3YR
<br /> PRIMARY CONTACT: 0 OWNER NCEONTRACTOR 0 OTHER(Please Specify)
<br /> CONTACT NAME: CONTACT PHONE: pc-Lif-3 - .5--)r-3
<br /> t.. c , ck,\ CONTACT EMAIL: cm 5Q y
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<br /> AGREEMENT:1 hereby certify that I have read and examined this application and know the same to
<br /> 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 /> 0
<br /> /I / PERMIT#
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<br /> Own- /Authori e•Agent Sign. ure Date (Revised 9/23/2016)
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