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<br /> ELECTRICAL PERMIT APPLICATION
<br /> CITY OF EVERETT PERMIT SERVICES
<br /> 3200 CEDAR STREET, EVERETT, WA 98201
<br /> (P)425-257-8810 FAX 425-257-8857 J (E)everetteps@everettwa.gov www.everettwa.gov/permits
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<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 /> USyE�OF BUILDING:
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<br /> CONTRACT PRICE OF WORK:$ Q�O
<br /> NUMBER OF DEVICES if low voltage):
<br /> FIRE ALARM? ❑YES IN NO
<br /> ASSOCIATED BUILDING PERMIT# if applicable):
<br /> DESCRIPTION OF WORK:
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<br /> OWNER NAME: a,Vats �� '�� > TENANT NAME If Commercial):
<br /> OWNER MAILING ADDRESS: STREET \\
<br /> CITY �.:.,��.tt_.E:.. STATE y�� Zi P��L.a•J�
<br /> OWNER PHONE: (� �j�� �j�t U OWNER EMAIL:
<br /> CONTRACTOR NAME:
<br /> CONTRACTOR ADDRESS: STREET < W
<br /> CITY �OJ.�CJtY STATE
<br /> CONTRACTOR PHONE:yZ7_ CONTRACTOR EMAIL:
<br /> CONTRACTOR LIC.#(REQUIRED): k 's �'/Cn�.01 tA CITY OF EVERETT BUSINESS LIC.#(REQUIRED): (�, 'Sj '6
<br /> PRIMARY CONTACT: IN OWNER ❑CONTRACTOR ❑OTHER(Please Specify)
<br /> C NTACT NAME: CONTACT PHONE:
<br /> CONTACT EMAIL:
<br /> AGREEMENT:T hereby certify that t 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 I
<br /> comply with the State Contractors Law 18.27 RCW and 296.200 WAC.
<br /> City of Everett Oficial Use Only
<br /> FEE
<br /> PERMIT#
<br /> e
<br /> Owner/Authorized Agent Signature Date (Revised 10/1212015)
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