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ELECTRICAL PERMIT PLIGATION <br /> • <br /> CITY OF EVERETT PERMIT VIC <br /> ITES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> (P)425-257-8810 ] FAX 425-257-8857 ] (E)everetteps@everettwa.gov] www.everettwa.gov/permits <br /> P O,JECT7 SI'Tl INFORiViA i <br /> PROJECT ADDRESS: '!, 1 D <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 /> EERIIL <br /> APi'06M-1044 WFO, RM- ATI®R9 <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: <br /> CONTACT WORMATION <br /> OWNER NAME: TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET <br /> CITY STATE ZIP <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: c ^ <br /> CONTRACTOR ADDRESS: STREET p <br /> CITY STATE ZIP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> CONTRACTOR LIC.#(REQUIRED): CITY OF EVERETT BUSINESS LIC.#(REQUIRED): <br /> PRIMARY CONTACT: H❑ OWNER ❑CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: <br /> CONTACT EMAIL: <br /> AGREEMENT. Thereby certify that 1 have read and examined this application and know the same to be true and correct. Ali provisions oflaws and ordinances governing this <br /> type of work will be completed whether speciffed 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 /> PER fMIIT,�# <br /> \ E 4 lL OUB �b <br /> Owner/Authorized Agent Signature Date (Revised 10/12/2015) <br />