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� <br />� <br />�ECTRICAL 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 />� <br />PROJECT ADDRESS: - ��`�--� .� �. �/ �.-c� � :r�i?,� �. /�'', �'� <br />BUILDING AREA (if residential, new construction, remode , or addition) ��v [�- 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: ��`' ��, ,��) �'.hr � �a(' � �:� �� T� U � n� %.td.Gl � <br />/��_ � <br />CONTACT INFORMATION <br />OWNER NAME: f���_� � � �� , >�,�- �_ a, � _,�-�` TENANT NAME (If Commercial): <br />OWNER MAILING ADDRESS: srREET <br />CITY STATE ZIP <br />OWNER PHONE: OWNER EMAIL: <br />CONTRACTOR NAME: `_> �,, �� � ry '� I C� <br />CONTRACTOR ADDRESS: sTReer i( r�� �� �-- 2 � cJ� f,� � <br />� �� � � <br />CITY j�;� f � � STATE `� ZIP �[,� <br />CONTRACTOR PHONE: CONTRACTOR EMAIL: <br />CONTRACTOR LIC. #(REQUIRED): 1--�,'��<-� ZI 1�"7 �1 `7C; CITY OF EVERETT BUSINESS LIC. #(REQUIRED): �� �i % <br />PRIMARY CONTACT: ❑ OWNER �ONTRACTOR ❑ OTHER (Please Specify) <br />CONTACT NAME: ---� � CONTACT PHONE: �� t�-"_ �7 � <br />�- � <br />: -- � � .� 6 � .�5 .�,j ._.� <br />! _:�=-�,�� _,:�`._���� CONTACT EMAIL: <br />AGREEMENT: T hereby certify that I have read and examined this application and know the same to be true and correct. All provisions of laws and ordinances governing this <br />type of work will be completed whether specifred herein or not. The granting of a permit does not presume to give authority to violate or cance/ 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 1 <br />comply with the State Contractors Law �8.27 RCW and 296.200 WAC. <br />v � � %i <br />Owner/Au orized Agent Signature <br />�� /� �/� r.'^ <br />Date <br />City of Everett Officia/ Use Only <br />FEE <br />� �� � <br />\�� <br />0 <br />PERMIT # <br />E I � 12-1 l <br />(Revised 10/12/2015) <br />