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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 1 FAX 425-257-8857 1 (E) everetteps@everettwa.gov I www.everettwa.gov/permits <br /> PROJECT SITE INFORMATION <br /> PROJECT ADDRESS: �(J c'_ U —U 3 (� <br /> BUILDING AREA(if residential, new construction, remodel, or addition) SF <br /> BUILDING TYPE: ❑ SFR-DETACHED ❑ SFR-ATTACHED ❑ DUPLEX ❑ MULTI-FAMILY-#OF UNITS: 'F:!!'EOMMERCIAL <br /> USE OF BUILDING: Av\�C1_.\-". <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK: $ 1 (v j oZ <br /> NUMBER OF DEVICES (if low voltage): <br /> FIRE ALARM? ❑YES DINO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIPTION OF WORK: 3 v A c­k <br /> t r1 /ljc,r y�__ 3 <br /> CONTACT INFORMATION <br /> OWNER NAME: 3 c: n TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET b U W, -t <br /> CITY LL) t1'C. STATE ZIP <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: <br /> CONTRACTOR ADDRESS: STREET e <br /> //�� <br /> CITY (L.e3' ✓h.ci✓ J STATE ZIP �- <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: .r t e_\G <br /> CONTRACTOR LIC.#(REQUIRED): ,S(��� _ CITY OF EVERETT BUSINESS LIC.# QUIRED) <br /> PRIMARY CONTACT: ❑OWNER ONTRACTOR ❑ OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: <br /> CONTACT EMAIL: <br /> AGREEMENT:1 hereby 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 type <br /> 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 1 <br /> comply with the State Contractors Law 18.27 RCW and 296.200 WAC. <br /> City of Everett Official Use Only <br /> PERMIT# <br /> �i ►-7 E l :JoG <br /> Owner/Authorized Agent Signature Date (Revised 9/23/2016) <br />