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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: &("-Sz k A )CL, <br /> BUILDING AREA(if residential, new construction, remodel, or addition) SF <br /> BUILDING TYPE: ❑ SFR-DETACHED ❑ SFR-ATTACHED ❑ DUPLEX ❑ MULTI-FAMILY-#OF UNITS: ❑ COMMERCIAL <br /> USE OF BUILDING: �— <br /> (ECECTR'ICAL PPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK: $ <br /> NUMBER OF DEVICES (if low v tage): <br /> FIRE ALARM? ❑YES ❑ NO <br /> ASSOCIATED BUILDING pi=pm 1)1Aof ap le): <br /> DESCRIPTION OF WORK: <br /> CONTACT INFORMATION <br /> OWNER NAME: CK) TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET <br /> CITY STATE ZIP <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: �' -y <br /> CONTRACTOR ADDRESS: STREET •CJ �� y7 <br /> CITY ? / �S STATE ZIP C <br /> CONTRACTOR PHONE:atG (0 CONTRACTOR EMAIL: leCVnCc Y\h 2 /j <br /> CONTRACTOR LIC.#(REQUIRED): CITY OF EVERETT BUSINESS LIC.#(R UIRED): <br /> PRIMARY CONTACT: ❑ OWNER XCONTRACTOR ❑OTHER(Please Specify) <br /> CO TACT NAME: CONTACT PHONE: il * <br /> CONTACT EMAIL: h I )164- <br /> AGREEMENT., <br /> 164-AGREEMENT:1 hereby certify that I have read and examined this application and know the same to be true and correct. All provisions of fawrMd 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 1 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 <br /> 40.. .t6nz.d Agent signature Date (Revised 9/23/2016) <br />