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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 I FAX 425-257-8857 I (E)everetteps@everettwa.gov I www.everettwa.gov/permits
<br /> PROJECT SITE INFORMATION: •:. •
<br /> PROJECT ADDRESS: 1 CD 100 i L Sr E V&o.f±.) - q 4 / ( . . ,.
<br /> BUILDING AREA(If residential,new construction,remodel,or addition) SF A ed..
<br /> BUILDING TYPE: 0 SFR-DETACHED ❑SFR ATTACHED 0 DUPLEX 0 MULTI-FAMILY-#OF UNITS: A COMMERCIAL
<br /> USE OF BUILDING:
<br /> ELECTRICAL PLICATION INFORMATION'
<br /> CONTRACT PRICE OF WORK: al"0 L)L). v 9
<br /> •
<br /> NUMBER OF DEVICES (if low v.'tage): .
<br /> FIRE ALARM? ❑YES ❑NO
<br /> ASSOCIATED BUILDING PERMI (if applicabl-,.
<br /> DESCRIPTION OF WORK: 12e 0 "._ Ccn.d i t-g Mir G'cI k ,�?V7 - *eta,a,.,., `:
<br /> .•511_.LI t � , 'v` eto yeV- C i v'e6"...e` - d f .
<br /> '. : w. •_.. _ CON`1'ACT iNk:iiti111AT1oN • ., • . .. . ,
<br /> OWNER NAME: c j4,11.,S'0'+ tt �,s✓ L TENANT NAME(If Commercial):
<br /> OWNER MAILING ADDRESS: STREE7jCI. l eig"15 I
<br /> CITY G t .-il— STATE ,t,t/A zip A',%.-is'
<br /> OWNER PHONE: OWNER EMAIL:
<br /> CONTRACTOR NAME:
<br /> t - IC i NC
<br /> CONTRACTOR ADDRESS: STREET PC , 1
<br /> CITYLA14-"CS V STATE A.di ZIP r 4 SV
<br /> CONTRACTOR PHONE: it,- ' - CONTRACTOR EMAIL: C.Q iteteettrItiote noldf In k
<br /> '� ,. ,*y
<br /> CONTRACTOR LIC.#(REQUIRED): : CITY OF EVERETT BUSINESS UC.#(REQUIRED):
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<br /> PRIMARY CONTACT: DOWNER 0 CONTRACTOR 0 OTHER(Please Specify)
<br /> CONTACT NAME: CONTACT PHONE: `; c(I 't ;) —%
<br /> ( L,rt-Ji.'`Li''t s-iv-L. CONTACT EMAIL: 0
<br /> AGREEMENT:T hereby certify that I have read and examined this application and know the same to be true and correct. All provisions of laws end ordinances governing this
<br /> type 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 1 em 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 298.200 WAC.
<br /> City of Everett Official Use Only
<br /> FEE
<br /> t d2 • 5C
<br /> PERMIT#
<br /> ,/f(/..."26: ' ".•61/:1:1-) 1-� (1C. - (o
<br /> Owfl luthorized Agent Signature ate (Revised 10/12/2015)
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