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,- ELECTRICAL PERMIT APPLICATION <br /> .x 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.gavlpermits <br /> PROJECT ADDRESS <br /> BUILDING AREA(if residential,new eonstructlon,remodel,or addition) S <br /> BUILDING TYPE: =R-DETACHED 0 SFR-ATTACHED 0 DUPLEX 0 MULTI-FAMILY-.#OF UNITS:. 0 COMMERCIAL, <br /> USE OF BUILDING; <br /> n ELECIlitle" L)A P144t: 1O* P—71 itititA71110,4 <br /> CONTRACT PRICE OF WORK: $ "—" <br /> NUMBER OF DEVICES(II low voEtas) <br /> FIRE ALARM? D YES ❑.Np <br /> ASSOCIATED BUILDING PERMIT#(I 'aplfoeble)k <br /> ) <br /> DES-CR£ tDF Wo <br /> RK! <br /> { * NY` <br /> ..,.t �, .... ate :. <br /> OWNER NAME: <br /> A 'I✓r a TENANT NAME If Commercial., <br /> OWNER MAILING ADDRESS. <br /> CITY. "ai at,. <br /> STATE <br /> � ria .� <br /> 40 <br /> OWNER PHONE , ' OWN EMAIL <br /> CONTRAaTOR NAME :' jilt A;e <br /> CONTttACToR ADDRESS: <br /> . OUTS - +'44/144, I <br /> C N ? <br /> OT F3 PHONE; e, Tip CONTRACTOR EMAIL. <br /> O t*e.IRI , ;���"` � <br /> ` .:.: . C OF EVERETT BUSINESS LIC # ECUIRED); <br /> PRIMARY CONTACT: 0 OWNER rS <br /> CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE <br /> �n <br /> " fie, CONTACT EMAIL <br /> lei Low* OclieVitle_an r8.AGREEMENT:t hereby certify that t have read and examined this application and know the same to be true and correct. All provtslons of l enordinances 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 orcencet 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 and i <br /> comply with the State Contractors Law 18.27 RCW and 296.200 WAC. <br /> COG/Everett Official Use Only <br /> PERMIT# <br /> :: °I 1u E l�GC - <br /> Owner/Atr n.axed Agent SIgr�"atuYe :. <br /> Date (Revised 8/23/2016) <br />