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n=n—ECTRICAL PERMIT Q.'��°[��C���'a oO� <br /> CITY OF EVERETT PERMIT SLKVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> (P) 425-257-8810 FAX 425-257-8857 (E) everetteps@everettwa.gov I www.everettwa.gov/permits <br /> PROJECT SITE INFORMATION <br /> PROJECT ADDRESS: Z7 -' `t l T <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 AP PUCATION 5INIF=VIATION <br /> CONTRACT PRICE OF WORK:$ <br /> NUMBER OF DEVICES (if low voltage): <br /> FIRE ALARM? ❑YES ❑ NO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIPTION OF WORK: <br /> � 11 CONTACT.INFORMATION <br /> OWNER NAME: L \v• TENANT NAME(if Commercial): <br /> OWNER MAILING ADDRESS: STREET 8� <br /> CITY V� �\ STATE ZIP -S! <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 c ❑CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT 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 specified 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 l am authorized by the owner of this property to perform the work for which application is made and f <br /> comply with the State Contractors Law 18.27 RCW and 296.200 WAC. <br /> City of Everett Official Use Only <br /> FEE <br /> PERM�ITi4f /� <br /> EVlJ ll/ CC I <br /> OwnerlAutliorized Agent Signature Date (Revised 10/12/2015) <br />