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� <br />� <br />ECTRICAL <br />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: 1 � ( -� � S (� <br />BUILDING AREA (if re � ential, new construction, remodel, or addition) SF <br />BUILDING TYPE. SFR-DETACHED ❑ SFR-ATTACHED ❑ DUPLEX ❑ MULTI-FAMILY-# OF UNITS: ❑ COMMERCIAL <br />USE OF BUILDING: j �„� � ' <br />ELECTRICAL APPLICATION INFORMATION <br />CONTRACT PRICE OF WORK: $ �� , ;,�, <br />NUMBER OF DEVICES (if low volta e): <br />FIRE ALARM? O YES ❑ NO <br />ASSOCIATED BUILDING PERMIT # (if applicable): <br />DESCRIPTION OF WORK: � �; �� �;.`; "' �, v - �� ��n;= � <br />�;� <br />CONTACT INFORMATION <br />OWNER NAME: �; " � � C�� TENANT NAME (If Commercial): <br />OWNER MAILING ADDRESS: srRee-r '- . ; � � � '�L S — <br />� r. j <br />CITY -'t�,f-�;'L� STATE � . ZIP r �-4(A: <br />OWNER PHONE: �� %> - �' j� OWNER EMAIL: <br />CONTRACTOR NAME: r `�±i � ) r� � '-� � / �; �` <br />CONTRACTOR ADDRESS: sTReEr � C � � ,, � <br />�j. 7 �� <br />CITY ''Q� ��, � � � STA7E r �A/Y� ZIP � � JJ' <br />CONTRACTOR PHONE: �% '�%,�SS-SS% �, , CONTRACTOR EMAIL• �' 'c� �' ci k eI�'���=� �, �� . C G+-^i <br />CONTRACTOR LIC. #(REQUIRED): CITY OF EVERETT BUSINESS LIC. #(REQUIRED): �'j.� <br />PRIMARY CONTACT: WNER ❑ CONTRACTOR ❑ OTHER (Please Specify) <br />CONTACT NAME: CONTACT PHONE: � -- '7 S-�+ -�" <br />���� � � � �, •�: CONTACT EMAIL: <br />AGREEMENT: 1 hereby ceRify that I have read and examined this applicaG'on and knowthe same to be true and correct. All provisions oflaws and ordinances goveming this type <br />of work wi!! be completed wfiether specified herein or not. The granting of a permit does not presume to give authonfy to violate or cancel the provisions of an}� other state or <br />local law regulating construction or the perfonnance of construction. Tfiat I am authorized by the o inmer of this propzrty to peifonn the v�brk for which application is made and I <br />comply with the State Contractors Law 18.27 RCW and 296.200 WAC <br />re <br />Date <br />City of Everett Official Use Only <br />PERMIT# <br />E��LI-I�°� <br />(Revised 9/23l2016) <br />