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01 -�st5rlq(� <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 /> BUILDING AREA(it residential, new construction, remodel,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 volta e : <br /> FIRE ALARM? ❑YES %ANO <br /> ASSOCIATED BUILDING PERMIT# if a licable <br /> DESCRIPTION OF WORK: <br /> CONTACT INFORMATION <br /> OWNER NAME: TENANT NAME(If Commercial): <br /> \ C <br /> OWNER MAILING ADDRESS: sTREer <br /> CITY \I STATE Zi? <br /> OWNER PHONE: nn _ OWNER EMAIL: <br /> CONTRACTOR NAME: 1 <br /> CONTRACTOR ADDRESS: s1uEEr 1 V <br /> CITY STATE ZIP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> CONTRACTOR LIC.#(REQUIRED): ` CITY OF EVERETT BUSINESS LIC.#(REQUIRED): <br /> PRIMARY CONTACT: ❑OWNER `.CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: <br /> 1Ukl CONTACT EMAIL: <br /> AGREEMENT Thereby 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 <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 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 /> FEE <br /> PERMIT# — <br /> �1 I E <br /> Ownerhothorized Agent Signature Date (Revised 10/12/2015) <br />