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i°1111?ate. <br /> ELECTRICAL PERMIT APPLICATION <br /> a CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> (P) 425-257-8810 ( FAX 425-257-8857 1 (E) everetteps@everettwa.gov 1 www.everettwa.gov/permit; <br /> PR.O4ECT,SITE:N 14 FORMATI I <br /> PROJECT ADDRESS; <br /> BUILDING AREA if rug ca^tiaI, new a , vtio' ----- <br /> amolei, Jr aJd+}EDn) SF <br /> BUILDING TYPE: 0 St=R-Di_T-t::Hc) Q 5= aTTA^H-) 0 0; ?_=t <br /> 0 MULTI-FAMILY_it Dr UNITS: Q ^,Oigrlt:IcRClr1_ <br /> USE OF BUILDING- <br /> '' <br /> UILDING;., L CTRI CAL APL1 Yt MAttot <br /> HPORM <br /> CONTRACT PRICE OF WORK: $ <br /> NUMBER OF DEVICES (if low voltage): <br /> FIRE ALARM? 0 YES 0 NO <br /> ASSOCIATED BUILDING PERMIT# if applicable�: <br /> 0 ESCRIETIOIst.OF WORK:._ <br /> doprAel '19RMA!IOIrI <br /> OWNER NAME , ` <br /> •_ .+� _-- TENANT NAME If Commercial : <br /> OWNER MAILING ADORES-• STREET- p Ore t 0 <br /> rr< s ...0 {}/� f cia <br /> 3,„„ "V.i, 7, -. <br /> OWNER PHONE: 0 1 IL-4- OWNER EMAIL: <br /> rONTRACTOR NAME: tT <br /> A—f- .. ter t"° <br /> s:DNTi :TOR ADDRESSS: srz-:=r ) I o b- +.t •:" r* <br /> ,nr� <br /> CI N STA T ZIP <br /> CONTRACTOR PHONE; /'� q3 2o i <br /> • , ,c • CONTRACTOR EMAIL: t 'j # r , <br /> _. . UN r RA�I�-L10;'�{RcOuiREa}:�1'1�E1f► }, ..�/ �# y • , a 601i I —T—rd's _.._.__.._CITY OF EVERETT BUSINESS LIC.#(REQUIRED); 00"' <br /> PRIMARY CONTACT: 0 OWNER sAt CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: <br /> n CONTACT PHONE: 6 5. a <br /> I % te CONTACT EMAIL: 663;t ciiy,,, <br /> AGREEMENT:I hereby certify that I have road and examined this application and know the same to be true end correct. Alt provisions Iewa endcoordinancesgoverning <br /> of work will be completed whether specified herein or not. The granting of a permit does not presume to give euthority to violate or cancel the provisions of any other statthis e 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 type <br /> comply with the State Contractors Law 18.27 RCW and 296.200 WAC. <br /> City ofEvarett Official Use Only <br /> CLQ PERMIT# <br /> .� . , c o E n 0 -- 2 <br /> Cwner/Authorized Agent Signature <br /> Cate <br /> (Revised 912312016) <br />