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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 I www.everettwa.gov/permits <br /> PROJECT SITE INFORMATION <br /> PROJECT ADDRESS: 0 <br /> BUILDING AREA(if residential, new construction, re I,or addition) W a SF <br /> BUILDING TYPE: ❑SFR-DETACHED ❑SFR-ATTACHED ❑DUPLEX ❑MULTI-FAMILY-#OF UNITS: ❑COMMERCIAL <br /> USE OF BUILDING: G�( ) <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK: $ <br /> NUMBER OF DEVICES (if low voltage): <br /> FIRE ALARM? D YES ❑NO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> r � <br /> DESCRIPTION OF WORK: k ��( G z',' U <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: CJ <br /> CONTRACTOR ADDRESS: STREET <br /> c" STATE ZIP v <br /> CONTRACTOR PHONE: Q �Sl0;5 , CONTRACTOR EMAIL: V v r✓ QG��(( U <br /> CONTRACTOR LIC.#(REQUIRED): d?j �O CITY OF EVERETT BUSINESS LIC.#(REQUIRED- <br /> PRIMARY CONTACT: WNER CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: 2-0a <br /> �N\ 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 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 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 /> PERMIT# <br /> O n gent1gna ure Da (Revised 10/12/2015) <br />