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0 . 0 <br /> 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 vwvw.everettwa.gov/permits <br /> PROJECT SITE INFORMATION <br /> l� <br /> PROJECT ADDRESS: ) VA,vt of <br /> BUILDING AREA(if residential, new construction, remodel,or addition) SF itj <br /> ,BUILDING TYPE: ❑ SFR-DETACHED ❑ SFR-ATTACHED ❑ DUPLEX ❑ MULTI-FAMILY-#OF UNITS: XC MMERCIAL <br /> USE OF BUILDING: <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK: $ ^RAP0.CU <br /> NUMBER OF DE\110ES (if low voltage): <br /> FIRE ALARM? ❑YES ❑ NO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIPTION OF:WORK: Woe .r(.Q,a,bnua` �c-ma <br /> CONTACT INFORMATION <br /> OWNER NAME: C, LC TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET VO <br /> CFFY STATE ZIP <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: <br /> CONTRACTOR ADDRESS: STREET <br /> CITYffiaq?ws STATE ZIP <br /> CONTRACTOR PHONE: aw CONTRACTOR EMAIL: <br /> CONTRACTOR LIC. `(REQUIRED) ky CITY OF EVERETT BUSINESS LIC.#(RE <br /> PRIMARY CONTACT: 17.9WNER ❑CONTRACTOR )?OTHER(Please Specify) d�i�ecfey.- <br /> CONTACT NAME: CONTACT PHONE: L ,— 3Z 17 <br /> IarAMO CONTACT EMAIL: O <br /> AGREEMENT.-T here y certify that/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/ <br /> comply with the State Contactors Law 18.27 RCW and 296.200 WAC. <br /> City of Everett Official Use Only <br /> FEE <br /> 0 <br /> PERMIT# <br /> Ej � o� -� <br /> OwherAuthorized Agent Signature Date (Revised 10/12/2015) <br />