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� <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: oG I � � <br />BUILDING AREA (if residential, new construction, eY model r addition) SF 1���� <br />BUILDING TYPE: ❑ SFR-DETACHED ❑ SFR-ATTACHED ❑ DUPLEX ❑ MULTI-FAMILY -# OF UNITS: ❑ COMMERCIAL <br />USE OF BUILDING: �j� c,�„�, •i,,� <br />ELECTRICAL APPLICATION INFORMATION <br />CONTRACT PRICE OF WORK: $ (� <br />NUMBER OF DEVICES (if low voltage): <br />FIRE ALARM? ❑ YES �O <br />ASSOCIATED BUILDING PERMIT #(if applicable): G� t`��� �(,N Z <br />DESCRIPTION OF WORK: � �� �•�-�, �� ��.�. (� I/�t �� i�u►-c �` <br />CONTACT INFORMATION <br />OWNER NAME: L �t-°� �� �^ UL�S �[.� TENANT NAME (If Commercial): <br />OWNER MAILING ADDRESS: sTReeT <br />CITY STATE ZIP <br />OWNER PHONE: OWNER EMAIL: <br />CONTRACTOR NAME: ��/✓1 , 2 /.} (/ (,Q. � �� � <br />CONTRACTOR ADDRESS: srREEr ,Z� �( ( O �'� Z nt,d �! 3, l�'r�•I �;c`�- � � �! • <br />S��� U'\I �/ +�\ CITY STATE �N �T ZIP �� ✓ � � � <br />CONTRACTOR PHONE: L'i Z-� ��{� c)� S� CONTRACTOR EMAIL: <br />CONTRACTOR LIC. #(REQUIRED): r� ss ��i � N-,- CITY OF EVERETT BU5INESS LIC. #(REQUIRED): D S� C-� L � <br />PRIMARY CONTACT: OWNER ❑ CONTRACTOR ❑ OTHER (Please Specify) <br />CONTACT NAME: n � CONTACT PHONE: (�( L,� 3� �y (��j S� <br />/� �, <br />j�—C CONTACT EMAIL: `(�v\ � L��Z, �,t,/� � r(�tl•.,�� <br />AGREEMENT: T hereby certi(y 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 comp/eted 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 construction or the pertormance of construction. That l 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 />Z-Z�;-�5� <br />OwnerlAuthorized Ay�nt Signature Date <br />City of Everett Official Use Only <br />FEE <br />�� �U <br />� _� <br />� <br />PERMIT # <br />EI5 2� . <br />(Revised 10/12/2015) <br />