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0 0 <br /> ELECTRICAL 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 /> C PROJECT SITE INFORMATION <br /> PROJECT ADDRESS: ��� J <br /> BUILDING AREA(if residential, new construction,remodel,or addition) SF <br /> BUILDING TYPE: ❑SFR-DETACHED ❑SFR-ATTACHED ❑DUPLEX ❑ MULTI-FAMILY-#OF UNITS: 2LMMERCIAL <br /> USE OF BUILDING: <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK: $ -6 p00 , meo <br /> NUMBER OF DEVICES if low volta e): <br /> FIRE ALARM? ❑YES NO <br /> ASSOCIATED BUILDING PERMIT# if applicable): <br /> DESCRIPTION OF WORK: QOvt Off' <br /> o L. <br /> CONTACT INFORMATION <br /> OWNER NAMEy TENANT <br /> �.N�,AME(If Commercial��L� >P <br /> OWNER MAILING ADDRESS: sTRE- T W <br /> CITY STATE Zlp I S� <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: GQou yoG. <br /> CONTRACTOR ADDRESS: STREET J�rNr=�7 <br /> CITY Q D STATE I"7-- ziP Q <br /> CONTRACTOR PHONE: _S6t)0 CONTRACTOR EMAIL: kA,2C , O MA <br /> CONTRACTOR LIC.#(REQUIRED): KECIE Leo? CITY OF EVERETT BUSINESS LIC.#(REQUIRED):dL/ Q <br /> PRIMARY CONTACT: ❑OWNER CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME- CONTACT PHONE: p s6 , 9-211? , r SD 2 <br /> � �u� ,�/ w 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. rhe granting of a permit does not presume to give authority to violate or cancel the provisions of arty 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 l <br /> comply with the State Contractors Law 16.27 RCW and 296.200 WAC. <br /> City of Everett Official Use Only <br /> FEF; <br /> PERMIT# <br /> OwnerlAuthoric d gent Signature Date (Revised 1 0/1 212 0 1 5) <br />