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1 <br /> 0 <br /> ELECTRICAL PERMIT APPLICATION <br /> N <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> (P) 425-257-8810 FAX 425-257-8857 1 (E) everetteps@everettwa.gov I www,everettwa.gov/permits <br /> PROJECT SITE iw RIVIATION <br /> PROJECT ADDRESS: i 6YI S � .. . a .' �_ . , 2 <br /> BUILDING AREA(if residential, new construction, remodel, or addition) SF <br /> BUILDING TYPE: ❑SFR-DETACHED ❑SFR-ATTACHED ❑ DUPLEX ❑ MULTI-FAMILY-#OF UNITS: OMMERCIAL <br /> USE OF BUILDING: o <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK: $ <br /> NUMBER OF DEVICES if low voltage): _ <br /> FIRE ALARM? ❑YES _NO <br /> ASSOCIATED BUILDING PERMIT# (if applicable): V II <br /> DESCRIPTION OF WORK: <br /> I <br /> i <br /> i <br /> I <br /> CONTACT INFORMATION <br /> OWNER NAME: t o TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET <br /> CITY STATE ZIP <br /> OWNER PHONE: n. C� • � OWNER EMAIL: ( j <br /> CONTRACTOR NAME: <br /> CONTRACTOR ADDRESS: STREET \ Iry C <br /> //CITY -5. �`� STATE ZIP <br /> CONTRACTOR PHONE: 1. CONTRACTOR EMAIL: <br /> CONTRACTOR LIC.#(REQUIRED): SINESS LIC.#(REQUIRED): j <br /> PRIMARY CONTACT: ❑OWNER ONTRACTOR ❑OTHER(Please Specify)_ <br /> CONTACT NAME: CONTACT PHONE: <br /> oqlet� "6 A�j CONTACT EMAIL: <br /> AGREEMENT.Thereby certify 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 violate or cancel the provisions of any other state or <br /> local law regulating construction or the performance of construction. That 1 am authorized by the owner of this property to perform the work for which application is made and I <br /> comply with the State Contractors Law 18.27 RCW and 296.200 WAC. i <br /> City of Everett Oficial Use Only <br /> FEE <br /> — PERMIT# <br /> (Ice E'er <br /> Owner/Authorized Agent Signature Date (Revised 10/12/2015) <br />