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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 1 (E) everetteps@everettwa-gov I www.everettwa.gov/permits <br /> PROJECT SITE INFORMATION <br /> PROJECT ADDRESS: !t +C` '� <br /> BUILDING AREA(if residential, new construction, remodel,or additio ) ti A7 SF <br /> BUILDING TYPE: 13SFR-DETACHED O SFR-ATTACHED 0 DUPLEX ❑ MULTI-FAMILY-#OF UNITS: O COMMERCIAL <br /> USE OF BUILDING: A : <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK: $ <br /> NUMBER OF DEVICES if low voltage): x---1 <br /> FIRE ALARM? ­O YES ©NO <br /> ASSOCIATED BUILDING PERMIT# if applicable): 1\� i� <br /> t <br /> DESCRIPTION OF WORK: Q A A-I -Ti t0 <br /> CONTACT INFORMATION <br /> OWNER NAME: >�.vr1 <-CX` (��C:.t TENANT NAME(If Commercial): _}} <br /> OWNER MAILING ADDRESS: STRE:E1 A S G ,j <br /> CITY �--liC'.�.'t ` STATE l.«.i 1� zip <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: � t �ti .. t;t..y..� <br /> CONTRACTOR ADDRESS: STREET <br /> CITY STATE �•'� ZIP <br /> CONTRACTOR PHONE: 3 S> 7�4 O (�. CONTRACTOR EMAfL: i vCLt(!?,Y Cq.. _C I r, 'll L> <br /> CONTRACTOR LIC.#(REQUIRED): , <br /> IN <br /> OF EVERETT BUSINESS LIC.#(I�EOUIRED): <br /> PRIMARY CONTACT: ❑OWNER �, ]-CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: ..£� _ y;) �, ?� <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 off is and ordinances governing this <br /> type of work will be completed 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 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 16.27 RCW and 296.200 WAC. <br /> d A' City of Everett Official Use Only <br /> 0i FEE <br /> FEE <br /> PERMIT# <br /> Owner/Authorized Agent Signature - Date (Revised 10/1212015) <br />