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0 0 <br />ELECTRICAL PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />(P) 425-257-8810 1 FAX 425-257-8857 1 (E) everetteps@everettwa.gov I www.everettwa.gov/permits <br />PROJECT SITE INFORMATION <br />PROJECT ADDRESS: <br />l % j�--j- — <br />BUILDING AREA (if residential, new construction, rem del, or addition) 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 ❑ NO <br />ASSOCIATED BUILDING PERMIT # (if applicable): <br />DESCRIPTION OF WORK: v Q <br />CONTACT INFORMATION <br />OWNER NAME: TENANT NAME (If Commercial): <br />OWNER MAILING ADDRESS: STREET <br />CITY STATE ZIP <br />OWNER PHONE: <br />OWNER EMAIL: <br />CONTRACTOR NAME: <br />CONTRACTOR ADDRESS: STREET <br />102 <br />GTY2, STATE ZIP <br />CONTRACTOR PHONE: 'qy7CONTRACTOR EMAIL: <br />CONTRACTOR LIC. #(REQUIRED): — (_._ <br />G <br />CITY OF EVERETT BUSINESS LIC. #(REQUIRED)G / <br />PRIMARY CONTACT: ❑ OWNER ❑ CONTRACTOR ❑ OTHER (Please Specify) <br />CONTACT NAME: <br />_ 1 <br />CONTACT PHONE: Q <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/ <br />comply with the State Contractors Law 18.27 RCW and 296.200 WAC. <br />City of Everett Official Use Only <br />PERMIT # <br />E 1 "4-o'4,-On <br />(Revised 912312016) <br />