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l ELECTRICAL PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> (P)425-257-8810 FAX 425-257-8857 I (E)everetteps@everettwa.gov( www.everettwa.gov/permits <br /> PROJECT.SITE INFORMATION <br /> PROJECT ADDRESS: r <br /> BUILDING AREA Of residential, new Con.strictior., remodel,or addition} <br /> m <br /> 5F <br /> BUILDING TYPE �IFrR-DETAC'-IED ❑�=R-ATTACHE? �DI.;PL n t <br /> EX ❑ uLTI-FAM1r1L -#OF UNITS commERoIA.L <br /> USE OF BUILDING; <br /> ELECTRICAL'APPLIGA`t`lioH41HF RRMitAtION <br /> CONTRACT PRICE OF WORK: $ CD •cc. <br /> NUMBER OF DEVICES (if low voltage): I ------- —" <br /> FIRE ALARM? 0 YES 0 NO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIPTIQN.of WARK:..._ <br /> _....._...... <br /> ......._..... <br /> / I I- Af.• - gra . • to Y • (3.Q, <br /> CONtAC? IN+II'OR AT1(ON <br /> OWNER NAME. 4k A <br /> TENANT NAME If Commercial <br /> OWNER MAILING ADDRESS: al <br /> sraEEr • i Y'; <br /> 1 ' 444111PRIM <br /> OWNER PHONE: 2 srA W <br /> '� ( � OWNER EMAIL: <br /> CONTRACTOR ADDRESS: �, I r <br /> Sr?�_r D act, <br /> ♦ <br /> CITY <br /> CONTRACTOR PHONE: STATE /t ` 20 I <br /> zip <br /> *Jog ��+► <br /> CONTRACTOR EMAIL: w 14` <br /> 44 ar � ►'�— CONTRACTOR LIC:NREc�Uit2EIhE.e d <br /> CITY OF EVERETT BUSINESS LIC.#(RECJUtRED)-V- <br /> PRIMARY CONTACT: 0 OWNER IX CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: <br /> CONTACT PHONE: Q5 R, t:), ;) <br /> € .Aa(C. CONTACT EMAIL: d • . <br /> AGREEMENT.!hereby certify that I have road end examined this application and know the same to be hue end correct. All pr sio�ns oflews andordinances <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 proWslons of any other state or <br /> local law regulating construction or the performance of construction. That t am authorized by the owner of this property to perform the work for which application Is made end type <br /> comply with the State Contractors Law 18.27 RCW and 296.200 WAC, <br /> City of Everett Official Use Only <br /> (, , PERMIT# <br /> ,, <br /> Owner/Authcarizad Agent Signature <br /> Date <br /> (Revised 9/2,'"""." -- <br />