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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 FAX 425-257-8857 1 (E)everefteps@everettwa.gov I www.everettwa.gov/permits <br /> PROJECT SITE INFORMATION ! <br /> PROJECT ADDRESS: �� Z O t�� G� 1��>K L� 27, 777 0/ <br /> BUILDING AREA(if residential,new construction,remodel,or addition) SF <br /> BUILDING TYPE: M SFR-DETACHED ❑SFR-ATTACHED D DUPLEX ❑MULTI-FAMILY-#OF UNITS: D COMMERCIAL <br /> [USE OF BUILDING: <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK: $ <br /> NUMBER OF DEVICES if low voltage): <br /> FIRE ALARM? Q YES NO <br /> ASSOCIATED BUILDING PERMIT# if applicable): <br /> DESCRIPTION OF WORK: 2CO /PM ✓���C-� E'' %�C'(�/���j�j� <br /> CONTACT INFORMATION <br /> OWNER NAME: �O %tc S O l7 TENANT NAME(if Commercial): <br /> OWNER MAILING ADDRESS: STREET <br /> cnv STATE lap <br /> OWNER PHONE: 206-, 17. 73 !Z6OWNER EMAIL: t�,' <br /> CONTRACTOR NAME: Z1/ 5? F/rr/' t c Z 1G-/rn j7 O Z LC_ <br /> CONTRACTOR ADDRESS: STREET /6.. <br /> Jnr P _7 O� STATE, ZIP <br /> CONTRACTOR PHONE:Z CONTRACTOR EMAIL: ` 2jt <br /> CONTRACTOR LIC.#(REQUIRED): `y ,1F� CITY OF EVERETT BUSINESS LIC. REQ IRED):r5n7Z;:�e�_ <br /> PRIMARY CONTACT: ❑OWNER CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: t�?� �j <br /> CONTACT EMAIL: L 2 e ftcf- /e <br /> AGREEMENT..Thereby certify that 1 have read and examined this application and know the same lobe true and correct. Alt provisions of laws aridOidin3nGGS 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 i am authorized by the owner of this property to perform the work for which appikation is made and I <br /> comply with the State Contractors taw 18.27 RCW and 296.200 WAC. <br /> City of Everett ficial Use Only <br /> FEE + f, <br /> PERMIT# / <br />