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�ECTRICAL PERMIT A�LICATION <br />CITY OF EVERETT PERMIT SERVICES <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 />PROJECT SITE INFORMATION <br />PROJECT ADDRESS: � � � �- <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: � r'�� <br />CONTACT INFORMATION <br />OWNER NAME: �, � V TENANT NAME (If Commercial): <br />OWNER MAILING ADDRESS: sTREET l,v /%l,L. <br />CI'TY '? e f'C°.� �1�- STATE (J��•� 1"� ZIP � <br />OWNER PHONE: � Z '�— ° �-- �C7 OWNER EMAIL: �� �,1 �-1rS f )t .L� GG M�ti� . L�fY� <br />CONTRACTOR NAME: v� � iC ti <br />CONTRACTOR ADDRESS: sTReET �� �,� <br />GTY �'�� � STATE �-7- ZIP Q <br />CONTRACTOR PHONE: �{ — 7— i� CONTRACTOR EMAIL: <br />CONTRACTOR LIC. #(REc1UIRED): �v )�.5'a- (.,; v/ y E; CITY OF EVERETT BUSINESS LIC. #(REQUIRED): QZ��! <br />_ __ _ ___ <br />PRIMARY CONTACT: � OWNER ❑ CONTRACTOR ❑ OTHER (Please Specify) <br />CONTACT NAME: CONTACT PHONE: f� Zs 3 c. j�`��(� � <br />C,�ec�# ��-�;��'Y CONTACT EMAIL: <br />AGREEMENT: T hereby certify that I have read and examined this application and know the same to be frue and correct. All provisions of /aws and ordinances govemrng this <br />type of work will be completed whether specified herein or not. The granting of a permit does not p�esume to give authority to violate or cancel the provisions of any other state or <br />local law regulating construction or the perfo�mance of construction. That I am authorized by the owner of this properfy to perform the work for which application is made and 1 <br />comply with fhe Stafe Confractors Law 18.27 RCW and 296.200 WAC. <br />Owner/Authorized Agent <br />�a (��� j� <br />Date <br />Ciiy of Everett Official Use Only <br />FEE <br />� �15� .a0i <br />PERMIT # <br />E �(��— D°l <br />(Revised 10/12/2015) <br />