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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 SITIE INFORMATION <br /> PROJECT ADDRESS: (6—_'75 !,a <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 /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK: $ A �. <br /> NUMBER OF DEVICES (if low voltage): <br /> FIRE ALARM? ❑YES ❑ NO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIPTION OF WORK: <br /> l � <br /> CONTACT INFORMATION <br /> OWNER NAME:] ` TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET A �- <br /> CITY Q: v� STATE 1 ZIP <br /> OWNER PHONE: r C OWNER EMAIL: <br /> CONTRACTOR NAME: ` p • , p <br /> CONTRACTOR ADDRESS: STREET LA�) <br /> CITY ^Q STATE ZIPcl O> <br /> CONTRACTOR PHONE: --­3'3 CONTRACTOR EMAIL: \1 : •r'�!L± U <br /> CONTRACTOR LIC.#(REQUIRED). DCASS CITY OF EVERETT BUSINESS LIC.#(REQUIRED): j <br /> PRIMARY CONTACT: ❑OWNER CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: Qa, _ —, �cp j <br /> SS` CONTACT EMAIL: <br /> AGREEMENT:I hereby certify that I 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 1 am authori2ed by the owner of this property to perform the work for which application is made and/ <br /> comply with the State Contractors Law 18.27 RCW and 296.200 WAC. <br /> City of Everett Official Use Only <br /> PERMIT# <br /> Owner/Autho ized Agent ignature Date (Revised 9/23/2016) <br />