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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 FAX 425-257-8857 1 (E) everetteps@everettwa.gov I www.everettwa.gov/permits <br /> PROJECT SITE INFORMATION <br /> PROJECT ADDRESS: oL 7 <br /> BUILDING AREA(if residential, new construction, remodel, or addition) 4 6L-E SF <br /> BUILDING TYPE: ❑ SFR-DETACHED SFR-ATTACHED ❑ DUPLEX ❑ MULTI-FAMILY-#OF UNITS: ❑ COMMERCIAL <br /> USE OF BUILDING: Aml <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK: $ G <br /> NUMBER OF DEVICES (if low voltage): <br /> FIRE ALARM? ❑YES NO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIPTION OF WORK: <br /> Y <br /> CONTACT INFORMATION <br /> OWNER NAME: / TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET <br /> CITY E0 STATE ZIP <br /> OWNER PHONE: r OWNER EMAIL: <br /> CONTRACTOR NAME: (/t <br /> CONTRACTOR ADDRESS: STREET 2 M' <br /> CITY (, STATE ZIP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: 4 �� vi�4 QJ, <br /> CONTRACTOR LIC.#(REQUIRED): CITY OF EVERETT BUSINESS LIC.#(REQUIRED): {� <br /> PRIMARY CONTACT: ❑OWNER rAGONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT N E: CONTACT PHONE: <br /> CONTACT EMAIL: CI <br /> AGREEMENT./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/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 18.27 RCW and 296.200 WAC. <br /> City of Everett Official Use Only <br /> PERMIT# <br /> E I�lb�- X21 <br /> Owner/Authori r <br /> Signature D to (Revised 9/23/2016) <br />