Laserfiche WebLink
ELECTRICAL PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT RVICES <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 /> �ROJ -T-SIT A6 <br /> PROJECT ADDRESS: (4 &kk WA <br /> BUILDING AREA(if residential, new construction,remodel, or addition) &MW SF Zo Q <br /> BUILDING TYPE: ❑SFR-DETACHED FR ATTACHED ❑ DUPLEX ❑ MULTI-FAMILY-#OF UNITS: CI COMMERCIAL <br /> USE OF BUILDING: ✓ <br /> lELEGRIICAL. P >INIF®RMA'CIO <br /> FGOTRACT PRICE OF WORK:$ <br /> BEROF DEVICES (if low voltage): <br /> FIRE ALARM? ❑YES 4NO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIPTION F WO K: C <br /> CONTACT,IN . <br /> OWNER NAME: TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET <br /> CITY STATE ZIP <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: /�C�1 _ <br /> CONTRACTOR ADDRESS: STREET f /'T�1/ <br /> c <br /> CITY STATE ZIP <br /> CONTRACTOR PHONE: VNI14ev 1CONTRACTOR EMAIL: <br /> CONTRACTOR LIC.#(REQUIRED): D I-KV CITY OF EVERETT BUSINESS LIC.#(REQUIRED): <br /> PRIMARY CONTACT: ❑ OWNER DLONTRACTOR ❑ OTHER(Please Specify) Can <br /> CONTACT NAME: GONTACT PHONE: -� <br /> ��/� CONTACT EMAIL: <br /> AGREEMENT. Thereby 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 specked 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 1 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 98.27 RCW and 296.200 WAC. <br /> City of Everett Official Use Only <br /> FEE <br /> +"1� o. <br /> PERMIT# <br /> Owne tiioriz gent Signature Date (Revised 90/1212095) <br />