Laserfiche WebLink
T-LECTRICAL PERMIT AB"LI CATION <br /> CITY OF EVERETT PERMI ICES <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 ADDRESS: v <br /> BUILDING AREA(if residential,new construction,remodel,or addition) SF <br /> BUILDING TYPE: ❑ SFR-DETACHED ❑SFR ATTACHED ❑ DUPLEX ❑MULTI-FAMILY-#OF UNITS: COMMERCIAL <br /> USE OF BUILDING: <br /> ELEcxRICAL AI.C,TIQ ON ®RI"ON <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: oci <br /> -J t <br /> .COI1>]TACT�.IhIFO_RMATION <br /> OWNER NAM@_i j . TENANT NAME(if Commercial): <br /> OWNER MAILING ADDRESS: STREET r, <br /> crry STATE ZIP <br /> OWNER PHONE — OWNER EMAIL; <br /> CONTRACTOR NAME: 7 —" <br /> CONTRACTOR ADDRESS: STREET 15 * 1 f <br /> CRy V STATE W Zip <br /> CONTRACTOR PHONE:! — CONTRACTOR EMAIL: <br /> CONTRACTOR LIC,#(REQU[RED): L CITY OF EVERETT BUSINESS LIC.#(REQUIRED): <br /> PRIMARY CONTACT: ❑OWNERa CONTRACTOR ❑OTHER(Please Specify) <br /> CONTA T NAME: CONTACT PHONE: _ o <br /> CONTACT EMAIL: <br /> AGREEMENT.Thereby certify that/have read and 6x4ninid 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 specified herein ornot. 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 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 /> City of Everett Official Use Only <br /> FEE �I <br /> I/ C/' J <br /> PERMIT# <br /> I <br /> GvvoerlAutliorizedAgent tL e Date (Revised 10/12/2095) <br />