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0 <br /> fLECTRICAL PERMIT APPLICATION <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: <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: $ 26"Z2 -c_-Z) <br /> NUMBER OF DEVICES (if low voltage): Ito-116— <br /> FIRE <br /> i62✓FIRE ALARM? ❑YES NO <br /> ASSOCIATED BUILDING PERMIT# (if applicable): <br /> DESCRIPTION OF WORK: <br /> CONTACT INFORMATION <br /> OWNER NAME: t TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET 'Z/ C) 9 T <br /> CITY 65 v/ 6 [ CiTr STATE "VG ZIP ��?U <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: e ( j�-/G 2 <br /> CONTRACTOR ADDRESS: STREET ��O(: /L-CIT (�/ 7 <br /> CITY r�(/ STATE t4 ZIP GE/ <br /> CONTRACTOR PHONE:4jA2_`7 -3 I-1—q0/9' CONTRACTOR EMAIL: <br /> CONTRACTOR LIC.#(REQUIRED): C t'j t C, C) CITY OF EVERETT BUSINESS LIC.#(REQUIRED): 2-- <br /> PRIMARY <br /> PRIMARY CONTACT: f'OWNER ❑CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: <br /> �lL' JZlvf�t�7,r�f t CONTACT EMAIL: <br /> AGREEMENT.Thereby certify that 1 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 /> PERMIT# <br /> /7 /QZ6?/ S E [15 <br /> caner uthorized Agent Signature Date (Revised 10/12/2015) <br />