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�..ECTRICAL PERMIT A�LICATION <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: � �_ „� • �, -� { � (,i�,� <br />BUILDING AREA (if residential, new construction, remo el, or addition) SF <br />BUILDING TYPE: ❑ SFR-DETACHED ❑ SFR-ATTACHED ❑ DUPLEX ❑ MULTI-FAMILY -# OF UNITS: t�'COMMERCIAL <br />USE OF BUILDING: <br />ELECTRICAL APPLICATION INFORMATION <br />CONTRACT PRICE OF WORK: $ Z� �'� ��� <br />NUMBER OF DEVICES (if low voltage : <br />FIRE ALARM? ❑ YES NO <br />ASSOCIATED BUILDING PERMIT # if applicable : <br />DESCRIPTION OF WORK: �,�� � �� �,�,�LS � X' (p �� �S. <br />CONTACT INFORMATION <br />OWNER NAME: C '�� TENANT NAME (If Commercial): �� �.- '�" <br />OWNER MAILING ADDRESS: srrteET 7,s� � t�� r� f <br />CITY ., i I(��/� STATE 7�✓1 ZIP !D <br />OWNER PHONE: � � OWNER EMAIL: <br />CONTRACTOR NAME: NO� 2S� 1SL71'� <br />CONTRACTOR ADDRESS: srReeT qaO�I I ST PL N� <br />C ITY � p ��(� I i 1[� STATE V-� A ZIP 1 a O 72 <br />CONTRACTOR PHONE: �ia5- O( - Qo�O CONTRACTOR EMAIL: (' � � <br />CONTRACTOR LIC. #(REQUIRED): I�IO(�TIi EI Q� (Zp CITY OF EVERETT BUSINESS LIC. #(REQUIRED):O �jOro�I �I <br />PRIMARY CONTACT: ❑ OWNER I� CONTRACTOR ❑ OTHER (Please Specify) <br />CONTACT NAME: CONTACT PHONE: Q�Q,(" � n�edi SD n� GO Y� <br />OIQ, ��� CONTACTEMAIL: I-���j- CJt{' 06+� <br />AGREEMENT: T hereby certify that 1 have read and examined this application and know fhe same to be true and correct. All provisions of laws and ordinances goveming 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 construcfion 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 1 <br />comply with the State Contractors Law 18.27 RCW and 296.200 WAC. <br />— �c� � �c�i�, <br />Owner/Authorized Agent Signature � Date <br />City of Everett Official Use Only <br />FEE <br />� �t��e�� <br />PERMIT # <br />E� D-I�I <br />(Revised 10/12/2015) <br />