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NECTRICAL PERMIT APOICATION <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: ��, , `„v fir{ <br /> BUILDING AREA(if 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: $ GO <br /> NUMBER OF DEVICES (if low voltage): <br /> FIRE ALARM? ❑YES NO <br /> ASSOCIATED BUILDING PERMIT# if applicable): <br /> DESCRIPTION OF WORK: /'� �C L/ off... �- 4 j/' P,07 <br /> G ; G <br /> r <br /> W r/ <br /> CONTACT INFORMATION <br /> OWNER NAME: TENANT NAME If Commercial): <br /> OWNER MAILING ADDRESS: STREET t-4 , G <br /> CITY Vete STATE ZIP V•X <br /> OWNER PHONE: S3) 7X— JOWNER EMAIL: <br /> CONTRACTOR NAME: U�tA aUn eG /;L <br /> CONTRACTOR ADDRESS: STREET <br /> CITY /�� j F-6�1 ccSTATE zip <br /> CONTRACTOR PHONE: - 1- - CONTRACTOR EMAIL: �,�1rrs r 'I5%a7uCG C.Or� <br /> CONTRACTOR LIC.#(REQUIRED): ;fid SG Q� CITY OF EVERETT BUSINESS LIC.#(REQUIRED): / 3� <br /> PRIMARY CONTACT: ❑OWNER CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: ;y-A 7 7 <br /> T�tjCONTACT EMAIL: G r.. <br /> AGREEMENT:T 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 <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! <br /> comply with the State Contractors Law 18.27 RCW and 296.200 WAC. <br /> City of Everett Official Use Only <br /> FEE <br /> 0 <br /> PERMIT# <br /> Owner/Authorized Agent Signature Date (Revised 10/12/2015) <br />