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'� <br />� <br />LECTRICAL PERMIT APP 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 />PROJECTADDRESS: ���J ,s ���`, <br />BUILDING AREA (if residential, new construction, remodel, or addition) SF <br />BUILDING TYPE: ❑ SFR-DETACHED ❑ SFR-ATTACHED ❑ DUPLEX ❑ MULTI-FAMILY -# OF UNITS: ❑ COMMERCIAL <br />�' <br />USE OF BUILDING: � '- ��, <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): <br />DESCRIPTION OF WORK: . �� ::( ��=-�� ��/ ,,/) '�/�'„�J'-' f ,_. i' , 1cJ,iC <br />li' �'� <br />CONTACT INFORMATION <br />OWNER NAME: �/� �, 1,,;� � j TEN NT NAME (If Commercial): <br />/� r� , � �,� �l <br />OWNER MAILING ADDRESS: sTREer �- �� _J j, <br />CITY C.-- ��(7}/i"' � . STATE ��� ZIP <br />OWNER PHONE: � l'' % 7�`r��%� OWNER EMAIL: <br />CONTRACTOR NAME: , l �� t`'.�'�!�5 �I'< - �/ t; •_ ! �✓�': <br />CONTRACTOR ADDRESS: sTReer `�� i� � �� <br />c i1v �t�c,.- _. �-' � �' j� /' /7 L-' <br />STATF �jil/ ZI ��- �� � <br />CONTRACTOR PHONE:��J` �! -�3''���� CONTRACTOR EMAIL: <br />r-� n ,n �,t; <br />CONTRACTOR LIC. #(RECIUIRED): '�f J� 5��' - ` �� l'" CITY OF EVERETT BUSWESS LIC. #(REQUIRED):C���(S/S'�' <br />PRIMARY CONTACT: �OWNER L�ONTRACTOR ❑ OTHER (Please Specify) <br />CONTACT NAME: . , CONTACT PHONE: �ii�� -� ,J � --�/ -1j ��� � <br />���1_) ���.��t �,a CONTACTEMAIL: ��� �� � � 1���.:'C' ���; !''�' �GJ/,� <br />AGREEMENT: T hereby certify tirat I have read and examined this application and know the same to be true and correct. All provisions oflaws and ordinances governing this <br />fype of work will be completed whether specified herein or not. The granting of a permit does not presume to give authority to violafe or cance! the provisions of any other state or <br />loca! law regulating construction or the performance 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 />/`"l%� � <br />Owner/Authorized Agent Signature Date <br />City of Everett Officral Use Only <br />FEE <br />�/'ti (� s�„'_"s— <br />��\J <br />PERMIT # <br />E�C�(�-D� 1 <br />(Revised 10/12/2015) <br />