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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: 66, 3 E v <br /> BUILDING AREA(if residential, new construction, remodel, or addition) SF <br /> BUILDING TYPE: ❑ SFR-DETACHED ❑ SFR-ATTACHED ❑ DUPLEX ❑ MULTI-FAMILY-#OF UNITS: XKCOMMERCIAL <br /> USE OF BUILDING: m <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK: $ //� <br /> NUMBER OF DEVICES (if low voltage): <br /> FIRE ALARM? ❑YES J<NO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIPTION OF WORK: 9tAn(/ of �10() TOCK <br /> CONTACT INFORMATION <br /> OWNER NAME: h t 2)t" L2 n! TENANT NAME(if Commercial): <br /> OWNER MAILING ADDRESS: STREET 66/�2 /3 f/r v PQL1 q (Iy/`Ay <br /> CITY l�t/e.(� ez� STATE ,{y// ZIP &,2 <br /> OWNER PHONE: `t-1 s-6 — 5OWNER EMAIL: <br /> CONTRACTOR NAME: <br /> CONTRACTOR ADDRESS: STREET //'ZC 0-2 <br /> CITY /!/C t,L �� STATE ZIP <br /> CONTRACTOR PHONE: r <br /> Z t, CONTRACTOR EMAIL: <br /> ' <br /> CONTRACTOR LIC.#(REQUIRED): ' sr—``GL c� ` Cffl CITY OF EVERETT BUSINESS LIC.#(REQUIRED): 6) 35 V <br /> PRIMARY CONTACT: ❑OWNER <CONTRACTOR ❑ OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: j ��' yl/(i'' 2 <br /> CONTACT EMAIL: P�'��C C�G �' L/iI��G �[� Z <br /> AGREEMENT.Thereby certify that/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 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 98.27 RCW and 296.200 WAC. <br /> City of Everett Official Use Only <br /> FEE <br /> PERMIT# <br /> Owner/Authorized Agent Signature Date (Revised 90/92/2095) <br />