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RECTRICAL PERMIT APPLkATION <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: �120& <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 /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK: $ -SO&s t. <br /> NUMBER OF DEVICES (if low voltage): <br /> FIRE ALARM? ❑YES I&NO <br /> ASSOCIATED BUILDING PERMIT# if applicable): <br /> DESCRIPTION OF WORK: iZ E i-oc {Te- L&e5c j'R IC jL Gy Z6 1 5 i G �D�i 1 c 1v'i <br /> WALL DU)-ZiP( S IDgCG C V4iiJA <br /> CONTACT INFORMATION' <br /> OWNER NAME: G /= ve_ TENANT NAME(If Commercial): 42eu,1 <br /> OWNER MAILING ADDRESS: STREET U00 CebAk S 'j Lc <br /> CITY IEV&R'L_ STATE WA ZIP 2c� <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: <br /> CONTRACTOR ADDRESS: STREET <br /> CITY STATE ZIP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> CONTRACTOR LIC.#(REQUIRED): CITY OF EVERETT BUSINESS LIC.#(REQUIRED): <br /> PRIMARY CONTACT: ❑ OWNER ❑ CONTRACTOR J2�OTHER(Please Specify) UILjj,y6 <br /> CONTACT NAME: CONTACT PHONE: y' r)^_��f_ 1S2 <br /> Iq� igKe— C_tit� K CONTACTEMAIL,,A,, k <br /> AGREEMENT.T hereby 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 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 18.27 RCW and 296.200 WAC. <br /> City of Everett Official Use Only <br /> FEE <br /> PERMIT# <br /> E L( 0 <br /> Owner/Authorized Agent Signature Date (Revised 10/1212015) <br />