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OLT ECTRICAL 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: ` .. I for- <br /> BUILDING . <br /> AREA(if residential, new constru ,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 /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK: $ 15 � DD <br /> NUMBER OF DEVICES(if low voltage): <br /> FIRE ALARM? 0 YES 0 NO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): ,, <br /> DESCRIPTION OF WORK: S itcr p -P& I k'l� v °""t <br /> CONTACT INFORMATION • <br /> OWNER NAME: ( 254-u1 Y1.Vd TENANT NAME(If Commercial):11 <br /> OWNER MAILING ADDRESS: STREET NSI.Lf De0.cS ALL(,�Q e Iv <br /> CITY C r L1 I V LQ. STATEIA) zip U' <br /> OWNER PHONE: �L ?€D .Q 40 OWNER EMAIL: Ca-t it e-1._( `& ,(4u: I .Cb Uu( <br /> CONTRACTOR NAME: n (mLA.9--V <br /> CONTRACTOR ADDRESS: STREET <br /> CITY STATE ZIP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> CONTRACTOR LIC.#(REQUIRED): CITY OF EVERETT BUSINESS LIC.#(REQUIRED): <br /> PRIMARY CONTACT: 0 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 /> n PERM # <br /> fin, 1�t 1 I ' 001 <br /> 0 •lhoriz-• •gent Signature Date (Revised 9i23/2016) <br />