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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 � FAX 425-257-8857 � (E)everetteps@everettwa.gov � www.everettwa.gov/permits <br /> PROJECT SITE INPORMATION <br /> PROJECTADDRESS: ,����� �� c� � — � (`� C ' "� ��� <br /> BUILDING AREA(if residential, new construction, remodel,or addition) SF <br /> BUILDING TYPE: ❑ SFR-DETACHED I�SFR-ATTACHED ❑ DUPLEX ❑ MULTI-FAMILY-#OF UNITS: ❑ COMMERCIAL <br /> USE OF BUILDING: � ' C � �; <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK: $ � �lU�) <br /> NUMBER OF DEVICES (if low voltage): <br /> FIRE ALARM? ❑YES �..NO - <br /> ASSOCIATED BUILDING PERMIT applicable : <br /> DESCRIPTION OF WORK: �J� . '� <br /> ,.--� <br /> CONTACT INFORMATION <br /> OWNER NAME: 1 �� '� ' TENANT NAME If Commercial): <br /> OWNER MAILING ADDRESS: sTReer n� 7� " <br /> r ; <br /> ��TY �, -�r STATE z�P �,�; <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: � <br /> CONTRACTOR ADDRESS: sTREET ��j > Th �� <br /> r. � \(� �- �-, <br /> CITY � �� ��{ , r{ STATC �Jl_�- ZIP �a�, <br /> CONTRACTOR PHONE:�'IZ�J �(�C7 - _�LC;;� CONTRACTOR EMAIL: 1Z.1 , �J ' ���,�� .� (�,� <br /> CONTRACTOR LIC.#(REQUIRED):1.��1 H Cli(�.���jL(�(�� CITY OF EVERETT BUSINESS LIC.#(REQUIR ): �� I 1X�j <br /> PRIMARY CONTACT: ❑OWNER �CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: !-�Z�j . ��.(� - GL j <br /> ��,� ��.�`J-� � CONTACT EMAIL: <br /> AGREEMENT.1 hereby eRify that I have�ead and examined fhis application and know the same to be true and correct. All provisions of laws and ordinances goveming 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 pertormance of construction. That 1 am authorized by the owner o/this property to perform the work for whir,h application is made and I <br /> comply with the State Contractors Law RCW and 296.200 WAC. <br /> City of Evereft Official Use Only <br /> � PERMIT# <br /> �� �� � E ��fl�j - � � <br /> OwnerlAutho zed ent Si atu Date (Revised 9/23/2016) <br /> \ <br />