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JOELECTRICAL PERMIT AOLICATION <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 www.everettwa.gov/permits <br /> PROJECT SITE INIFORI IATION <br /> PROJECT ADDRESS:! / y <br /> BUILDING AREA(if residential,new construction,remodel, or addition) SF <br /> BUILDING TYPE: ❑SFR-DETACHED ❑SFR-ATTACHED ❑ DUPLEX ❑ MULTI-FAMILY-#OF UNITS: k COMMERCIAL <br /> USE OF BUILDING: <br /> ELECTRICAL APPL ICATl-:,, INFORMATION <br /> CONTRACT PRICE OF WORK:$ Cj ) <br /> NUMBER OF DEVICES (if low voltage): <br /> FIRE ALARM? ❑YES "(NO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIPTION OF WORK: <br /> CO NTACT.INFORMATION <br /> OWNERN AME: ! TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET ,_„J <br /> CRY - STATE v ZIP <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: <br /> CONTRACTOR ADDRESS: STREET <br /> CITY STATE L <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> CONTRACTOR LIC.#(REQUIRED): CITY OF EVERETT BUSINESS LIC.#(REQUIRED): S <br /> PRIMARY CONTACT: ❑OWNER XCONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: 0 <br /> CONTACT EMAIL: <br /> AGREEMENT.,Thereby 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/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 98.27 RCW and 296.200 WAC. <br /> City of Everett Official Use Only <br /> FEE <br /> - PERMIT# <br /> Enb� - off <br /> Owner/Authorized Age- " nature Date (Revised 90/1212095) <br />