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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 /> PROJECT ADDRESS: ��,_' � C�' I � �,i t �. � �' �` L "L <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: ��C�v�� <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK: $ /�� � <br /> NUMBER OF DEVICES (if low voltage): Z- <br /> FIRE ALARM? ❑YES ❑ NO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIPTION OF WORK: � �:�t��� �c � �-� � � �; t��� � (%�t� �'c`�� ,�l�r�� L� � <br /> CONTACT INFORMATION <br /> OWNER NAME: TENANT NAME(If Commercial): C'���� S '��`� �� �-- <br /> OWNER MAILING ADDRESS: sTReer <br /> C ITY STATE ZIP <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: �: t'� �' l � j G �,� ,�� ,� Z'+'Y'l `> <br /> CONTRACTOR ADDRESS: sTREET � (j�' Ct � (Li'SC,d-� ��-'G;('r <br /> CITY ���� �'� � STATE �'�� �� ZIP ��'�' �'� <br /> CONTRACTOR PHONE: � ��7 ] � " ,' � �� `� CONTRACTOR EMAIL: 7�"l� L I �,`� '� ���C'F I��L � �!'�� .� i'i�, � �i �'r- � <br /> �1 IW' f J � <br /> CONTRACTOR LIC.#(REQUIRED): ��� j�` ��5��� �� ��; '� CITY OF EVERETT BUSINESS LIC.#(REQUIRED): <br /> PRIMARY CONTACT: ❑OWNER �CONTRACTOR ❑ OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: � � '�� � ` � j� <br /> �`L���,li1 G'� ��'./�-r' �, CONTACT EMAIL: '- �;�I.i L� �� �✓ ,i�,��, .. 'r �,,��'� � �il'��� •(��; <br /> AGREEMENT:T hereby certify that 1 have read and examined this application and know the same to b true and correct. All provisions of laws aiid ordinances 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 peKorm 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 /> �0�� <br /> � ' PERMIT# <br /> i <br /> .� ,,��;���� �- ���1,�=�-- � � E �'�v0 7-- (� <br /> Owner/Authorized Agent Sign�ture D te (Revised 10/12/2015) <br />