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� <br />�_ <br />� <br />� <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 �(E) everetteps@everettwa.gov � www.everettwa.gov/permits <br />PROJECT SITE INFORMATION <br />PROJECT ADDRESS: � �, Z� 1�j � � � j �; � �,' � �; . ,: .j-4 � �( zU <br />BUILDING AREA (if residential, new construction, remodel, or addition) SF <br />BUILDING TYPE: ❑ SFR-DETACHED ❑ SFR-ATTACHED ❑ DUPLEX ❑ MULTI-FAMILY -# OF UNITS: C�OMMERCIAL <br />USE OF BUILDING: <br />ELECTRICAL APPLICATION INFORMATION <br />CONTRACT PRICE OF WORK: $ ' ; � <br />NUMBER OF DEVICES (if low voltage): � v�, <br />FIRE ALARM? ❑ YES �-1� <br />ASSOCIATED BUILDING PERMIT # (if applicable): <br />DESCRIPTION OF WORK: - �;•;, r., ' ti.�- S, c,kj � <br />CONTACT INFORMATION <br />OWNER NAME: ^-t �. �; ,� ' TENANT NAME (If Commercial): S' <br />OWNER MAILING ADDRESS: sTReer <br />CITY STATE ZIP <br />OWNER PHONE: Zc:.�(� - '�-��/ - u3 I% OWNER EMAIL: <br />CONTRACTOR NAME: —' -�-; -�c:c (� �G "ti� t �t\�C<l ��` c-� � <br />CONTRACTOR ADDRESS: sTReeT ` " fK - <br />CITY 5 ) ; i�., -.�� STATE \..�'� l"� ZIP e%�� 'rj <br />CONTRACTOR PHONE: 3 ,-(�� -- "(�� CONTRACTOR EMAIL: <br />CONTRACTOR LIC. #(REQUIRED): '^ ,-�- L CITY OF EVERETT BUSINESS LIC. #(REQUIRED): �J`jt�7 � <br />PRIMARY CONTACT: ❑ OWNER ONTRACTOR ❑ OTHER (Please Specify) <br />CONTACT NAME: CONTACT PHONE: L.rZs'_ G`7(0 -��J � <br />' i �c� � `,��c;,.,�vt4�e��-c-� CONTACT EMAIL: <br />AGREEMENT: T hereby certify 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 pertormance of construction. That l 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. <br />�� <br />�� 2z-�s-- <br />Agent Signature Date <br />City of Everett Official Use Only <br />FEE <br />� �C� <br />PERMIT # <br />E ��12-a� <br />(Revised 10/12/2015) <br />