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�-- 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 /> PROJECT ADDRESS: 1l <br /> =BUILDING AREA(If residential,new construction,remodel,orat:Mitten) SI <br /> - <br /> BUILDING TYPESFR-DETACHED 0 SFR-ATTACHED 0 DUPLEX CIMULTI-FAMILY-#OF UN ST 0 COMMERCIAL <br /> gr; <br /> USE OF BUILDING:; <br /> CONTRACT PRICE OF WORK: $ <br /> C° <br /> NUMBER OF DEVICES(if low volttage :. <br /> FIRE ALARM? 0 YES NO <br /> ASSOCIATED BUILDING PERMIT#(t#a®pticable),. <br /> .I3CRI!'TI4k _GE. lt:_ <br /> OWNER NAME: A ' 1.,!_......ii e . A. TENANT NAME it Cote rtdle ; <br /> OWNER MAILING ADDRESS: 11 y <br /> it el <br /> erre � � _ .. STATE 2 <br /> X1E' ` <br /> OWNER PHONE: j,j ' `fir -- <br /> 'j � L . : OWNER EMAIL: <br /> CONTRACTOR,NAME x 0 <br /> ' 9 <br /> .... ______., <br /> CON>RACTORADDRESS, STREET (4 r5 act <br /> CITY ..qd j STATE > <br /> a ZIP <br /> ,CONTRACTOR PHONE:`L &5C 095 CONTRACTOR.EMAIL: f e . - re) <br /> lief <br /> CONTRACTOR-Ur.fhasot#ReoyCAtt"lir'°r 1� s <br /> - CITY OF EVERETT BUSINESS LIC IRftl»OUllt>rG) 00 p <br /> PRIMARY CONTACT: 0 OWNER fi, CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: <br /> CONTACT PHONE: <br /> 45 95: a ie CONTACT EMAIL <br /> t?E l41Ef#T limb .. , . 'cony) <br /> AG <br /> y rffy that?:have read and examined this application and know the same to be true and correct. All provisions of laws end ordinances governing this type <br /> ofwa f 3.ji beco toted 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!am authorized by the owner of this property to perform the work for which application is made end t <br /> comply with the State Contractors Law 18.27 RCW and 296.200 WAC. <br /> City of Everett Official Use Only <br /> PERMIT# <br /> Owner/Authorized Agent Sig?aura Date <br /> (Revised 9/23/2016) <br />