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ELL:'%,TRICAL PERMIT APPI-JUKTION <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 /> 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 /> I1L9CTRICAL APPLICATION INFORMATION <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: Q- <br /> CONTACT INFORMATION <br /> OWNER NAME: 0 TENANT NAME If Commerciall: <br /> OWNER MAILING ADDRESS: aTREET <br /> CITY STATE ZIP <br /> OWNER PHONE: Was goliOWNER EMAIL: <br /> CONTRACTOR NAME: -,n <br /> CONTRACTOR ADDRESS: STREET f <br /> CnY STAtE Zlp 1 <br /> p ti { CONTRACTOR EMAIL; <br /> CONTRACTOR PHONJ <br /> CONTRACTOR LIC.#(REQUIRED): r CITY OF EVERETT BUSINESS LIC.#(REQUIRED): <br /> PRIMARY CONTACT: ❑ OWNER ACONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: y <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 ord;-Ifencas 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 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 /> 00 <br /> PERMIT# <br /> Eno�- <br /> Owner/Authorized Agent Signature Date (Revised 1011212015) <br />