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<br /> ELECTRICAL IT 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
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<br /> PROJECT ADDRESS: /,'(7 /17. S,i ., 4 nv e
<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: -
<br /> CONTRACT PRICE OF WORK: $ �pva
<br /> NUMBER OF DEVICES (if low voltage):
<br /> FIRE ALARM? 0 YES ►` NO
<br /> ASSOCIATED BUILDING PERMIT#(if applicable):
<br /> DESCRIPTION OF WORK: /9c/d S / / k t4 /
<br /> � f 1 t
<br /> a v ILA .1_,, R..., pt e en, A i Ae 4,c,...-, 4......."' ,i._,
<br /> CLQ,✓D- �11A� %
<br /> J CINT # TtFQRMi.Tl�O1+11
<br /> OWNER NAME: L h c 4 U ev, it,- TENANT NAME(If Commercial):
<br /> OWNER MAILING ADDRESS: STREET /Y7 7 /12. .e.i.,-d -9 < r C %
<br /> CITY e L C l z f STATE 41,1'e C ZIP 7 y2 c..
<br /> OWNER PHONE: 'd 4. 2 5/ '/3 2/ OWNER EMAIL:
<br /> CONTRACTOR NAME: ,r.-, P C/ 6'/ . f rr ¢ 41 C
<br /> CONTRACTOR ADDRESS: STREET J/- 5'rr s�e E-Jot'i' � ,
<br /> CITY /,j 9 4v STATE �'2/` �j o• ZIP 2 O . :12.
<br /> CONTRACTOR PHONE: 3/o 757 /30v CONTRACTOR EMAIL: .O04'e.-- 3 to s.0 le,,,e• , h) `1
<br /> CONTRACTOR LIC.#(REQUIRED): /o s`o7 ci /Yeez/C CITY OF EVERETTJBUSINESS LIC.#(REQUIRED)•,'2/ r7
<br /> PRIMARY CONTACT: ❑OWNER 0 CONTRACTOR 0 OTHER(Please Specify)
<br /> CONTACT NAME: CONTACT PHONE:
<br /> CONTACT EMAIL:
<br /> AGREEMENT:I hereby certify that I have read and examined this application and know the same to be 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 /> ,// " ,
<br /> PERMIT#
<br /> E 'lSlo . -` 5
<br /> Owner/Authorized Agent Signature Date (Revised 9/23/2016)
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