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� <br />�� <br />� <br />� <br />ELECTRICAL PERMIT APPLICATION <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: /�' �) �l%..��' �:� �y � � c.�C1 ' <br />� <br />BUILDING AREA (if residential, new construction, remodel, or addition) SF <br />BUILDING TYPE: ❑ SFR-DETACHED ❑ SFR-ATTACHED ❑ DUPLEX ❑ MULTI-FAMILY -# OF UNITS: Cy'G�MMERCIAL <br />USE OF BUILDING �, = ` <br />ELECTRICAL APPLICATION INFORMATION <br />CONTRACT PRICE OF WORK: $ 'G����� <br />NUMBER OF DEVICES (if low voltage): <br />FIRE ALARM? ❑ YES ❑ NO <br />ASSOCIATED BUILDING PERMIT # (if applicable): <br />DESCRIPTION OF WORK: •� . _� u,c� 1�Ll:. �-v<'c � <br />CONTACT INFORMATION <br />OWNER NAME: �U�4 r� � ,,:�_�-c.: ,,,.�_ TENANT NAME (If Commercial): <br />OWNER MAILING ADDRESS: sTReer � C�, <br />CITY �(��'.,i�� STATE / ZIP L. ,�/c-i�� <br />OWNER PHONE: OWNER EMAIL: <br />CONTRACTOR NAME: % ' ���-� v _��_. <br />CONTRACTOR ADDRESS: srReeT � �/ � �'� > � _j � <br />CITY /� �Q�.i9� STATE .-L��l�'-` ZIP �\; <br />CONTRACTOR PHONE: 'a ` j,�, j' CONTRACTOR EMAIL: ���tw r 7� j S/r �-� � , <br />CONTRACTOR LIC. #(REQUIRED): �� � ��,�y� /'� ��,�� _ CITY OF EVERETT BUSINESS LIC. #(REQUIRED):.�� �S� � ' <br />PRIMARY CONTACT: ❑ OWNER C�LONTRACTOR ❑ OTHER (Please Specify) <br />CONTACT NAME: CONTACT PHONE: ' <br />� / <br />i� G, �Sj � �� <br />� CONTACT EMAIL: <br />AGKttMtN l: I hereby certiry fhat 1 have read and examined this application and know the same to be true and correct. All provislons of laws and ordinances governing this type <br />of work will be completed whether specified herein or not. The granting of a permit does not presume to give authoriry to violate or cancel the provisions of any other state or <br />local law regulating construction or the pertormance of construction. That / 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 />,:G � --� <br />Owner/Authorized Agent S <br />Date <br />City of Everett Official Use Only <br />PERMIT # <br />E «c�—t�� <br />(Revised 9/23/20i6) <br />