Laserfiche WebLink
�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: �,�-(,S �CC<� ��_ �,.Q,�',� j,(,�' � '� <br />BUILDING AREA (if residential, new construction remodel 'or addition) SF ���'�� j <br />BUILDING TYPE: SFR-DETACHED ❑ SFR-ATTACHED ❑ DUPLEX ❑ MULTI-FAMILY -# OF UNITS: ❑ COMMERCIAL <br />y� •q r � <br />USE OF BUILDING: I"1-E'- I�l-�'/ l� [ c� <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: ���'�-�i� .� .0 SC t �j--�,z �'-Q.-P'U7 Ce.� (,U !l'^� �j�(�!� <br />� <br />CONTACT INFORMATION <br />OWNER NAME: ������ � L�%�7L' TENANT NAME (If Commercial): <br />OWNER MAILING ADDRESS: sTREEr � �S«�7� �� <br />CITY � �.���� ' � STATE ���� ZIP � �> � ' <br />OWNER PHONE: C� �' OWNER EMAIL: <br />CONTRACTOR NAME: . � 1'��%���--- <br />CONTRACTOR ADDRESS: sTREEr <br />CITY STATE ZIP <br />CONTRACTOR PHONE: CONTRACTOR EMAIL: <br />CONTRACTOR LIC. #(REQUIRED): CITY OF EVERETT BUSINESS LIC. #(REQUIRED): <br />_ _ __ _ . <br />PRIMARY CONTACT: L�OWNER ❑ CONTRACTOR OTHER (Please Specify) �' <br />CONTACT NAME: CONTACT PHONE: '?��G Gi� � l � <br />CONTACT EMAIL: <br />AGREEMENT: T here6y certify that I have read and examined this application and know the same fo be true and correct. A!l provisions of laws and ordinances governing this <br />type of work will be completed whether specified herein or not. The granting of a permii does not presume to give authority fo violate or cancel the provisions of any other state or <br />local law regulating construction or the performance of construction. That I 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 />r�,�/c��� , :���s�'� <br />Agent Signature <br />Date <br />2� j � <br />City of Everett Officral Use Only <br />FEE <br />� j r�� ��" <br />� l lj l�j ,/ <br />PERMIT # <br />E �l� b — �� <br />(Revised 10/12/2015J <br />