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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 1 FAX 425-257-8857 (E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> :> . _.:::..•.....: '....:. . ...P1tiO�lEGT.SITE AN ORMATION. <br /> PROJECTADDRESS: <br /> BUILDING AREA(if residential,new construction,remodel,or addition) SF <br /> BUILDING TYPE: FR-DETACHED ❑SFR-ATTACHED ❑ DUPLEX ❑MULTI-FAMILY-#OF UNITS: ❑COMMERCIAL <br /> USE OF BUILDING: <br /> ELECTRICAL;APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK:$ <br /> NUMBER OF DEVICES (if low voltage): <br /> FIRE ALARM? ❑YES ❑NO <br /> ASSOCIATED BUILDING PERMIT d#(if applicable): <br /> DESCRIPTION OF WORK: 4 ( r /2 fw <br /> CONTACT INFORMATION <br /> OWNER NAME: �/ �� TENANT NAME(if Commercial): <br /> OWNER MAILING ADDRESS: STREET Z —7 <br /> COY /�/`� _ y STATE Z!P 1 <br /> : L <br /> OWNER PHON - OWNER EMAIL: ✓v <br /> CONTRACTOR NAME: lh c <br /> CONTRACTOR ADDRESS: STREET 'L(Z� Cc CL <br /> CINlit!(�L STATE Wi,t - ZIP ( C� <br /> CONTRACTOR PHONE. Z-5 2-. ((4- CONTRACTOR EMAIL: ke b't GES <br /> CONTRACTOR LIC.#(REQUIRED): SS°• ZDV CITY OF EVERETT 1.BUSWESS LIC.#(REQUIRED):60 <br /> PRIMARYCONTACT: ❑ OWNER CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: '�.ta 26—2-— 2 11 LL <br /> auo CONTACTEMAIL: <br /> AGREEMENT.•T hereby cediry that t have read and examined this application and know the same to be true and correct. All provisions of laws and ordinances governing this I <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 I <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 /> T:bq=-, <br /> i <br /> PERMIT# <br /> -2� -1 <br /> Owner/Authorized Agent Signature Date (Revised 10/12/2095) <br /> 9 <br /> F <br />