Laserfiche WebLink
SIELECTRICAL PERMIT OPLICATION <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 wvvw.everettwa.gov/permits <br />PROJECT SITE INFORMATION <br />ROJECT ADDRESS: <br />S `u1 K.� 1/ I I ! l /r �IU� <br />BUILDING AREA (if residential, new construction, remodel, or addition) SF <br />BUILDING TYPE: ❑ SFR-DETACHED <br />❑ SFR-ATTACHED ❑ DUPLEX ❑ MULTI -FAMILY - # OF UNITS: COMMERCIAL <br />USE OF BUILDING: v-! 6 iL� <br />ELECTRICAL APPLICATION INFORMATION <br />CONTRACT PRICE OF WORK: $ (� 1 <br />NUMBER OF DEVICES (if low voltage):, <br />FIRE ALARM? ❑ YES 19,NO <br />ASSOCIATED BUILDING PERMIT # (if applicable): ,( y <br />DESCRIPTION OF WORK:!1 / I Cr l <br />vl r n <br />CONTACT. INFORMATION . <br />OWNER NAME: TENANT NAME (If Commercial): <br />OWNER MAILING ADDRES STREET <br />CITY E` t STATE WA ZIP V 1 <br />OWNER PHONE: <br />OWNER EMAIL: <br />CONTRACTOR NAME: U rv\ <br />CONTRACTOR ADDRESS: STREET , l� <br />CITY :� ` �� STATE ZIP J� <br />CONTRACTOR PHONE: ":�N ' j •- L I %L <br />EMAIL: <br />CONTRACTOR LIC. #(REQUIRED): - t <br />/CONTRACTOR <br />l� <br />CITY OF EVERETT BUSINESS LIC, #(REQUIRED): , <br />PRIMARY CONTACT: ❑ OWNER %CONTRACTOR ❑ OTHER (Please Specify) <br />LHONE: <br />CONTACT NAME: I <br />�'� <br />CONTACT P <br />CONTACT EMAIL: <br />AGREEMENT.' Thereby certify that/ hat% read and examined this application and know the same to be Prue and correct. All provisions of laws and 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 / 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 />Owner/Autho/ized Agent SigMure <br />City of Everett Official Use Only <br />FEE <br />o <br />f PERMIT # <br />�lfl� E llJ� <br />Date (Revised 1011212015) <br />