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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 INFORMATION
<br /> PROJECTADDRESS: � �;1;,,, � � �� ,� �; °
<br /> BUILDING AREA(if residential,new construction, remodel,or addition) SF
<br /> BUILDING TYPE: ❑ SFR-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 volta e): ��%
<br /> FIRE ALARM? ❑YES C�NO
<br /> ASSOCIATED BUILDING PERMIT#(if applicable):
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<br /> DESCRIPTION OF WORK: ���,,, _� � � i �� �•,�:� i'���w,,��� .;.=���!�,_, C��:��_�:�-+"= i��: �C%4"� ' I��i " �'"���=,i'+�' ('
<br /> �'���'�
<br /> CONTACT INFORMATION
<br /> OWNER NAME: ��c-u�� I�° �;,�,n TENANT NAME(If Commercial):
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<br /> OWNER MAILING ADDRESS: sTReeT �I��= h,�s.C_�:,:'(" i Z
<br /> CIIY /��% � STATE �i��l ZIP J ,l��
<br /> OWNER PHONE: OWNER EMAIL:
<br /> CONTRACTOR NAME: � . � - I v�,_ I � � �
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<br /> CONTRACTOR ADDRESS: sTneeT I?'�?� ' �'9��2 `�j''
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<br /> GTY I V++./ , ,ti � STATE -i 1
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<br /> CONTRACTOR PHONE: S���'-��!�"�I ��� CONTRACTOR EMAIL: �f�,.• ,, �_�'�!'',)�l�-i�;.,;,c;��._ .--� i�., ' ,l�',� ,
<br /> CONTRACTOR LIC.#(REGIUIRED): �����, �;.� �'�_j j t�?!� CITY OF EVERETT BUSINESS LIC.#(REQUIRED): ���-�'�u�
<br /> PRIMARY CONTACT: �}OWNER ❑CONTRACTOR ❑OTHER(Please Specify)
<br /> CONTACT NAME: CONTACT PHONE: � "`��� y�
<br /> .:'�%._ � i •,
<br /> �,� ;��� �,jr�,-�I��.,�� CONTACT EMAIL: ��' �-:, [,f ti� ��--I��.�- � �•rN'^:�f��%:f.t�c�v�-c
<br /> AGREEMENT. T hereby certify that 1 have read and examined this application and know the same to be true and correct. All provisions of laws and ordinances goveming this
<br /> type of work wilt be compteted whether specified herein or no[ The granting of a permit does not presume to grve authority to vrolate or cancel the provisions of any ofher sfate 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 applrcation 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 /> FEE
<br /> �� '�O
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<br /> PERMIT#
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<br /> Owner/Authorized Agent Signature Date (Revised 10/12/2015)
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