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• • <br /> ELECTRICAL PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> (P)425-257-8810 1 FAX 425-257-8857 1 (E) everetteps@everettwa.gov I www.everettwa.gov/permits <br /> PROJECT SITE INFORMATION <br /> PROJECT ADDRESS: <br /> 06-00 f✓d1-G'�'��%.F' c1 Ll; <br /> BUILDING AREA(if residential,new construction,remodel,or addition) SF <br /> BUILDING TYPE: ❑ SFR-DETACHED ❑ SFR-ATTACHED ❑ DUPLEX ❑MULTI-FAMILY-#OF UNITS: 0 COMMERCIAL <br /> USE OF BUILDING:4LA <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK: $ V,cjW <br /> NUMBER OF DEVICES if low voltage): NIA <br /> FIRE ALARM? ❑YES ®NO <br /> ASSOCIATED BUILDING PERMIT# if applicable): <br /> DESCRIPTION OF WORK: T <br /> t3PYlr. <br /> CONTACT INFORMATION <br /> OWNER NAME; 6 TENANT NAME If Commercial : ,4C-tt <br /> OWNER MAILING ADDRESS: SIREE1 bG <br /> GfTY STATE WeAZIP <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: 1C._ <br /> CONTRACTOR ADDRESS: STREET I'7— t)?_L4�j(> <br /> S0jrT- <br /> STATEWAzip <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: t�j !^�3 fvt J�sTi�4ru U'f (-h]E-"— <br /> CONTRACTOR LIC.#(REQUIRED): CITY OF EVERETT BUSINESS LIC.#(REQUIRED): 015- <br /> PRIMARY CONTACT: ❑OWNER KCONTRACTOR ❑OTHER(Please Specify)__-__-_._ <br /> CONTACT NAME: CONTACT PHONE:, l <br /> CONTACT EMAIL: 36r4 7- <br /> AGREEMENT:Thereby certify that 1 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/am authorized by the owner of this property to perform the work for which application is made and t <br /> comply with the State Contractors Law 18.27 RCW and 296.200 WAC. <br /> city of Everett Official Use Only <br /> FEE <br /> 10( SCI <br /> PERMIT# <br /> E ((L'61 C <br /> uthorized Agent Signature Date (Revised 10112/2015) <br />