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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 1 FAX 425-257-8857 ( (E)everetteps@everettwa.gov l www.everettwa.gov/permits <br /> PROJECT ADDRESS: <br /> BUILDING AREA.(if residential„new construction. roniode! or addition) <br /> SF <br /> BUILDING TYPE; 0 SFR-DETACHED 0 SFR-ATTACHED 0 DUPLEX 0 MULTI-FAMILY-#OF UNITS: 0 COMMERCIAL <br /> USE OF BUILDING: <br /> �° �yc�� k{ kyr y#� <br /> Zf �t °RSR RI 4 riFii 'a jj' <br /> .x <br /> is � <br /> - - � jj[y(('{jj� <br /> CONTRACT PRICE OF WORK $ <br /> NUMBER OF DEVICES If low voltabe <br /> FIRE ALARM? 0 YES 0 NO <br /> ASSOCIATED BUILDING PERMIT# 2 €t tl . <br /> t�ble): <br /> 40) 41x <br /> t ,aa <br /> .tea et. �! <br /> OWNER NAME. j <br /> TENANT NAME(Ifrrelt lelP <br /> OWNER MAILING AOCKE <br /> CITY ','. t ..:.. ..... ........ <br /> OWNER PHONE: 4 , ”` na <br /> "• ` OWNER EMAIL:.. <br /> CONTRACTOR NAME: e <br /> ._., �.:�,1 try <br /> CONTRACTOR ADDRESS: <br /> STREET I 401 <br /> CITY <br /> CONTRACTOR PHONE srArE Zia <br /> mss ► -' ;* CONTRACTOR EMAIL: • '., " .*; ` <br /> jellnintallINIMIN CITY OF EVERETT BUSINESS LC.. SQUIRED): vrolglgtiat <br /> PRIMARY CONTACT: <br /> t3 OWNER 4: CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: <br /> CONTACT PHONE: Lia5 I <br /> 'ICONTACT EMAIL: <br /> AGREEMENT.•1 hereby certify that(have read and examined(his application and know the same to be true and correct. All provisions oflaWa 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 /> (LSC. PERMIT# <br /> j �. �� -�s EQ), <br /> OwnertArilt •rued Agent Signature I <br /> Date .. <br /> (Revised 9/23/2016) ,�° <br />