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�ECTRICAL PERMIT AI�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: �� �� 1�1 ��K`� � � V't�� L U��f c? ��� <br />BUILDING AREA (if residential, new construction, remodel, or addition) IwLS��C+I'�'���� 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 voltage): <br />FIRE ALARM? ❑ YES l�� NO <br />ASSOCIATED BUILDING PERMIT # (if applicable): <br />DESCRIPTION OF WORK: i�'� �U ; �� � �,�L,I <br />CONTACT INFORMATION <br />OWNER NAME: �� �� 5; Y� •^,,� TENANT NAME Qf Commercial): <br />OWNER MAILING ADDRESS: srREEr � 3� � ��n� �� i/� <br />CITY L�''(-e, `� STATE W � 1 ZIP <br />OWNER PHONE: OWNER EMAIL: <br />CONTRACTOR NAME: - ���juj, L'-�Y�G��I 5�.fv � L <br />CONTRACTOR ADDRESS: sTREer Q� �,�� � <br />CITY L(�� � S'�-�'� i�. S STATE ZIP G�� 5, <br />CONTRACTOR PHONE: �'� �j C� � ���j CONTRACTOR EMAIL: <br />CONTRACTOR LIC. #(REQUIRED): ~ h � •� � S Z�� CITY OF EVERETT BUSINESS LIC. #(REQUIRED): �L�1� <br />PRIMARY CONTACT: ❑ OWNER L�I CONTRACTOR ❑ OTHER (Please Specify) Z� C(Z �� 1.,-, - c� � ank e; <br />CONTACT NAME: ���Y i�\` CONTACT PHONE: �j � c�� � <br />�� <br />CONTACT EMAIL: <br />AGREEMENT: T hereby certify that / 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 fo 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 properfy to perform the work for which application is made and 1 <br />comply with the State Contractors Law 18.27 RCW and 296.200 WAC. <br />Owner/Authorized Agent Signature <br />Date <br />City of Everett Official Use Only <br />FEE <br />���,�� <br />PERMIT # <br />E I� 11 � �I� <br />(Revised 10/12/2015) <br />