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1 <br /> ELECTRICAL PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 4err 3200 CEDAR STREET, EVERETT, WA 98201 <br /> (P) 425-257-8810 1 FAX 425-257-8857 1 (E) everetteps@everettwa.gov www.everettwa.gov/permits <br /> t <br /> PROJECT SITE 1NFARMATION . <br /> PROJECT ADDRESS: Ulc <br /> BUILDING AREA(if residential, new Construction, remodel,or adc ition) SF y <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: $ C Cj <br /> NUMBER OF DEVICES(if low voltage): <br /> FIRE ALARM? ❑YES ON <br /> ASSOCIATED BUILDING PERMIT# (if applicable): <br /> DESCRIPTION OF WORK: CG <br /> 1 <br /> CONTACT INFORM4TION <br /> OWNER NAME: CV <br /> -(...0 TENANT NAME(If Commercial): <br /> t <br /> OWNER MAILING ADDRESS: STRrrT <br /> r <br /> CITY STATE ZIP � <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: - LLC <br /> CONTRACTOR ADDRESS: STREET 1402.. N�.1 SSC 1 Deo <br /> CITY STATE ZIP 1 <br /> CONTRACTOR PHONE:a - CONTRACTOR EMAIL: C�twC, W COYY� <br /> CONTRACTOR LIC.#(REQUIRED);� CITY OF EVERETT BUSINESS LIC.#(REQUIRED): <br /> PRIMARY CONTACT: O OWNER O CONTRACTOR OTHER(Please Specify)` <br /> CONTACT NAME: CONTACT PHONE: _ 4 _ U�--I <br /> CONTACT EMAIL: Y �� U <br /> AGREEMENT.'1 hereby certify that t have read and examined this application and know the same to be true and correct All pro 'ions 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 t li <br /> comply with the State Contractors Law 18.27 ROW and 296.200 WAC. i <br /> City of Everett Official Use Only <br /> PERMIT# <br /> l�(23�I�p E <br /> Owner/Authorized Agent Signature Date (Revised 972312016) <br />