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LECTRICAL PERMIT A[ i "ICATI®N <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> (P) 425-257-8810 FAX 425-257-8857 1 (E) everetteps@everettwa.gov I wvvw.everettwa.gov/permits <br /> PROJECT SITE INFORMATION <br /> PROJECT ADDRESS: <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: $ / ?, Al <br /> NUMBER OF DEVICES (if low voltage): <br /> FIRE ALARM? ❑YES OM-0 <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIPTION OF WORK: <br /> v 2 <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: - Uc) scn�E <br /> CONTRACTOR ADDRESS: STREET 1 <br /> CIN `nw 7 <br /> -` i�-; n STATE LAjk ZIP Q <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: (e, 'L; C <br /> CONTRACTOR LIC.#(REQUIRED): CITY OF EVERETT BUSINESS LIC.#(REQUIRED): <br /> PRIMARY CONTACT: ❑OWNER ELG6NTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: ��-�� <br /> (2's't l V-L'a CONTACT EMAIL: <br /> AGREEMENT.'T hereby 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/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 /> FEE <br /> PERMIT# I <br /> Owne/Auth riz gent Sig a Date (Revised 10/12/2015) <br />