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� <br />� <br />.S� PS �f dA L�h/� G L.�`'" ' r� <br />��ECTRICAL PERMIT APr�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 INFORMATI�N <br />PROJECT ADDRESS: �f'� �,s£ �j�'�£ 7� �J � <br />BUILDING AREA (if residential, new construction, remodel, or additionj SF <br />BUILDING TYPE: ❑ SFR-DETACHED ❑ SFR-ATTACHED ❑ DUPLEX ❑ MULTI-FAMILY -# OF UNITS: ❑ COMMERCIAL <br />USE OF BUILDING: �Q� L � j <br />� <br />ELECTRICAL APPLICATION INFORMATION <br />CONTRACT PRICE OF WORK: $ �j O D D,�° �' <br />NUMBER OF DEVICES (if low volta e): <br />FIRE ALARM? ❑ YES ❑ NO <br />ASSOCIATED BUILDING PERMIT # (if applicable): <br />DESCRIPTION OF WORK: j S%� L f �✓ f��/ff � /'j�! G/ �' � wC <br />CONTACi INFORMATION <br />OWNER NAME: c/ T`? 4� �/��`%`� TENANT NAME (If Commercial): <br />OWNER MAILING ADDRESS: sTReeT Q %� <br />CITY £ T� STATE �-- ZIP LO <br />OWNER PHONE: 2,5�-Z,s� -�Z Z� OWNER EMAIL: rQ �( � �%�E� k/fF, �Q!/ <br />CONTRACTOR NAME: � <br />CONTRACTOR ADDRESS: srREET <br />CITY STATE ZIP <br />CONTRACTOR PHONE: CONTRACTOR EMAIL: <br />CONTRACTOR LIC. #(REQUIRED): CITY OF EVERETT BUSINESS LIC. #(REQUIRED): <br />PRIMARY CONTACT: �OWNER ❑ CONTRACTOR ❑ OTHER (Please Specify) <br />CONTACT NAME: CONTACT PHONE: "— �- .- 8� S/'Z <br />� � ��(/ % CONTACT EMAIL: �(fT �j� r%� ,G O(� <br />AGREEMENT: T hereby certify that I have read and examined this application and know the same to be true and correct. AIl 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 I am authorized by the owner of this property to pertorm 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 />,- <br />; �, �- <br />l <br />Owner/Authorized Agent Signature <br />�--�-��--i� <br />Date <br />City of Everett Official Use Only <br />FEE , <br />���1�,�� <br />PERMIT # <br />EI��4�a1� <br />(Revised 10/12/2015) <br />