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ELECTRICAL PERMIT , 'PUGAflON <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 www.everettwa.gov/permits <br /> PROJECT SITE INFORliWATION <br /> PROJECT ADDRESS: <br /> BUILDING AREA(if residential, new construction,remodel,or addition) SF <br /> BUILDING TYPE: ❑SFR-DETACHED ❑SFR-ATTACHED ❑ DUPLEX ❑ MULTI-FAMILY-#OF UNITS: OIZOMMERCIAL <br /> USE OF BUILDING: C� <br /> ELECTRICAL APPLICATION IMFORIlI ATION <br /> fCOMNETRACT PRICE OF WORK: $ "A`�—Z� <br /> BER OF DEVICES (if low voltage): <br /> FIRE ALARM? YES ❑NO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIPTION OF WORK: <br /> INFORMATIO <br /> CONTACT. N <br /> OWNER NAME: TENANT NAME(if Commercial): , <br /> OWNER MAILING ADDRESS: STREET ' <br /> CITY STATE ZIP <br /> OWNER PHONE: � Jsv OWNER EMAIL: <br /> CONTRACTOR NAME: <br /> CONTRACTOR ADDRESS: STREET <br /> CITY STATE V\ ZIP L V <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> CONTRACTOR LIC.#(REQUIRED): CITY OF EVERETT BUSINESS LIC.#(REQUIRED): <br /> PRIMARY CONTACT: ❑ OWNERNTRACTOR ❑ OTHER(Please Specify) <br /> CONTACT NAME: kCONTAC'T PHONE: <br /> EMAIL: Al <br /> AGREEMENT.Tlwfeby 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 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 l <br /> comply with the State Contractors Law 18.27 RCW and 296.200 WAC. <br /> City of Everett Official Use Only <br /> FEE <br /> Iso <br /> PERMIT# <br /> Loi ® � IL <br /> O erlAut 0 A igna Date (Revised 10/1212015) <br />