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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 1 (E) everetteps@everettwa.gov I www.everettwa.gov/permits <br /> PROJECT SITE INFORMATION <br /> PROJECT ADDRESS: U <br /> BUILDING AREA(if residential, new construction, remodel, or addition) Z 0o 0 SF <br /> BUILDING TYPE: SFR-DETACHED ❑ SFR-ATTACHED ❑ DUPLEX ❑ MULTI-FAMILY-#OF UNITS: ❑ COMMERCIAL <br /> [USE OF BUILDING: S f Wy / <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK: $ Z <br /> NUMBER OF DEVICES (if low voltage): <br /> FIRE ALARM? ❑YES O <br /> ASSOCIATED BUILDING PERMIT# if applicable): <br /> DESCRIPTION OF WORK: Lnv14 <br /> CONTACT INFORMATION <br /> OWNER NAME: TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET <br /> CITY STATE ZIP <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: C-' //1 C V/ S—�— <br /> CONTRACTOR ADDRESS: STREET /y <br /> CITY L-�L f'f- (- �' STATE ZIP <br /> CONTRACTOR PHONE: — ��� CONTRACTOR EMAIL: <br /> CONTRACTOR LIC.#(REQUIRED): + AJ CITY OF EVERETT BUSINESS LIC.#(REQUIRED):Q <br /> PRIMARY CONTACT: ❑OWNER �kCONTRACTOR ❑ OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: L <br /> kb_6(�l � �s �.� ��, - `fir*/ S�/ CONTACT EMAIL: S' t LoC T 1�/� SC'�' VICe Q �o <br /> AGREEMENT:I he by certify that I have read and exam*rd this application and know the same to be true and correct. All provisions of laws and ordinances governing this type <br /> 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/am authorized by the owner of this property to perform the work for which application is made and/ <br /> comply with the State Contractors Law 18.27 RCW and 296.200 WAC. <br /> City of Everett Official Use Only <br /> PERMIT# <br /> Owner/Au rize� t Signature Date (Revised 9/23/2016) <br />