Laserfiche WebLink
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�` <br /> BUILDING AREA(if residential, new construction, remodel, or addition F <br /> BUILDING TYPE: ❑ SFR-DETACHED SFR-ATTACHED ❑ PLEX ❑ MULTI-YAM] -#OF UNITS: ❑ MMERCIAL <br /> USE OF BUILDING: N <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK: $ �C) <br /> NUMBER OF DEVICES (if low voltage): <br /> FIRE ALARM? ❑ YES NO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIPTION OF WORK: <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: `��� � _� C. A. <br /> CONTRACTOR ADDRESS: STREET <br /> CITY 1 /STATE ZIP <br /> CONTRACTOR PHONE: ) C/ —f CCONTRACTOR]EMAIL: ��l ��l <br /> G , <br /> CONTRACTOR LIC.#(REQUIRED): ' � � ITY OF EVERETT BUSINESS LIC.#(REQUI ED): <br /> PRIMARY CONTACT: ❑OWNER ONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME:__ CONTACT PHONE: zS ZI <br /> CONTACT EMAIL: <br /> AGREEMENT.I hereby certify that-l- ave 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 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 /> PERMIT# <br /> E PccJ - OS <br /> ner/Authorized Agolif Signature Date (Revised 9/23/2016) <br />