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(P) 425-257-8810 � <br />� � <br />ELECTRICAL PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />FAX 425-257-8857 �(E) everetteps@everettwa.gov � www.everettwa.gov/permits <br />PROJECT SITE INFORMATION <br />PROJECT ADDRESS: ,SG � C /G�% L�l(.,(� <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: $ �OG � <br />NUMBER OF DEVICES (if low voitage): <br />FIRE ALARM? ❑ YES ❑ NO <br />ASSOCIATED BUILDING PERMIT # (if applicable): <br />DESCRIPTION OF WORK: F!�/ ,1'G�J ( T�(�l lL D L% %'t J�'L �OiL.. /�d l�(� (, �J <br />CONTACT INFORMATION <br />OWNER NAME: �f LI C R.O �O TENANT NAME (If Commercial): <br />OWNER MAILING ADDRESS: srREeT SG/ �% C./�,�f� <br />CITY � STATE [�J ZIP 60(,(./ <br />OWNER PHONE: ,L,� �o� S% OWNER EMAIL: <br />CONTRACTOR NAME: ��L�I�./ f i�� <br />CONTRACTOR ADDRESS: sTReeT �p O ( <br />CITY STATE N.J ZIP 6� <br />CONTRACTOR PHONE: 7Zf �� � CONTRACTOR EMAIL: <br />CONTRACTOR LIC. #(REQUIRED): FL%LO�NJ��%I yZL/� CITY OF EVERETT BUSINESS LIC. #(REQUIRED): �l �.� <br />PRIMARY CONTACT: ❑ OWNER ❑ CONTRACTOR -0 OTHER (Please Specify) /s'LO �l!%�� OUI �— �..�p/� <br />CONTACT NAME: � CONTACT PHONE: (�u 1�� ,ZZ �Y <br />ll� ��Lr C.Q��'`,� CONTACT EMAIL: <br />AGREEMENT: T hereby certi(y 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 to vio/ate 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 pertorm the work for which application is made and l <br />comply with the State Contractors Law 18.27 RCW and 296.200 WAC. <br />0 <br />Agent Signature <br />'3� <br />D� <br />City of Everett Official Use Only <br />FEE <br />7�,T�� <br />PERMIT # <br />f E J(�0�-Zf� <br />(Revised 10/12/2015) <br />2 � <br />