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0 • <br />ELECTRICAL PERMIT APPLICATION <br />M <br />(P) 425-257-8810 <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />FAX 425-257-8857 1 (E) everetteps@everettwa.gov I www.everettwa.gov/permits <br />PROJECT SITE INFORMATION <br />PROJECT ADDRESS: r-7Z (-7 <br />BUILDING AREA (if residential, new construction, remodel, or addition) C �) SF <br />BUILDING TYPE: ❑ SFR-DETACHED ❑ SFR-ATTACHED ❑ DUPLEX ❑ MULTI -FAMILY - # OF UNITS: ❑ COMMERCIAL <br />USE OF BUILDING: <br />ELECTRICAL APPLICATION INFORMATION <br />CONTRACT PRICE OF WORK: $ <br />NUMBER OF DEVICES (if low voltage): <br />FIRE ALARM? ❑ YES O / <br />ASSOCIATED BUILDING PERMIT # (if applicable): / U U 3 L <br />DESCRIPTION OF WORK: L <br />4EZL <br />CONTACT INFORMATION <br />OWNER NAME: <br />�Qr �i!lf C� NAME (If Commercial): <br />OWNER MAILING ADDRESS: <br />STREET 7� 7 <br />TENANT <br />CITY <br />/ <br />STATE ZIP ' L C/2 <br />OWNER PHONE: , — <br />0 — L/ S�3v <br />OWNER EMAIL: <br />CONTRACTOR NAME: C> <br />- <br />CONTRACTOR ADDRESS: <br />STREET <br />CITY <br />STATE ZIP <br />CONTRACTOR PHONE: <br />CONTRACTOR EMAIL: <br />CONTRACTOR LIC. #(REQUIRED): <br />CITY OF EVERETT BUSINESS LIC. #(REQUIRED): <br />PRIMARY CONTACT: ❑ OWNER ❑ CONTRACTOR <br />❑ OTHER (Please Specify) <br />CONTACT NAME: <br />CONTACT PHONE: <br />CONTACT EMAIL: <br />AGREEMENT/ 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 / am authorized by the owner of this property to perform the work for which application is made and/ <br />comply with the State Contractors Law 18.27 RCW and 296.200 WAC. <br />Owner/Au orized Agent Signature Date <br />City of Everett Official Use Only <br />PERMIT # <br />E� <br />(Revised 912312016) <br />