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E�CTRICAL PERMIT AP�.ICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />(P) 425-257-8810 � FAX 425-257-8857 �(E) everetteps@everettwa.gov � www.everettwa.gov/permits <br />PROJECT SITE INFORMATION <br />PROJECT ADDRESS: � , � � <br />BUILDING AREA (if residential, new consf tion, remodel, or addition) SF <br />BUILDING TYPE: ; SFR-DETACHED ❑ SFR-ATTACHED ❑ DUPLEX ❑ MULTI-FAMILY -# OF UNITS: ❑ COMMERCIAL <br />USE OF BUILDING: L• r� <br />I CONTACT INFORMATION � <br />OWNER NAME: -=�'({ �-�'-1 (:l �a <br />OWNER MAILING ADDRESS: srREET <br />PHONE: %B � =, <br />ONTRACTOR NAME: <br />ONTRACTOR ADDRESS: <br />CONTRACTOR PHONE: <br />CITY <br />STREET <br />CITY <br />TENANT NAME (If Commercial <br />� � OWNER EMAIL: <br />. -", ! <br />i � �� <br />� <br />r <br />7�'i � .� CONTRACTOR EMAIL: <br />sra� ' ; � <br />l� 7 <br />STATE d J: <br />ZIP <br />ZIP <br />CONTRACTOR LIC. #(REQUIRED): `{-�;,��/l' f�j �{� �� �( �� �CITY OF EVERETT BUSINESJ LIC. #(REQUIREDr <br />PRIMARY CONTACT: ❑ OWNER � CONTRACTOR ❑ OTHER (Please Specify) <br />CONTACT NAME: CONTACT PHONE: ' ���� ., <br />�. <br />'� - � _ CONTACT EMAIL: � � i <br />AGREEMENT: T hereby certi that I 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 consfruction. That I am aufhorized by the owner of this property to perform the work for which application is made and I <br />comply with the State Contracfors Law 18.27 RCW and 296.200 WAC. <br />�. �1 � G-C�i,,, �,' ��' �� le ��, i � <br />Owner/Authorized Agent Si�ure Date <br />City of Everett O�cial Use Only <br />FEE <br />� <br />� �� . °.� <br />PERMIT # <br />E�� `� ��� <br />(Revised 10/12/2015) <br />