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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: ft-Vi - <br /> BUILDING AREA(if residential, new construction, remodel, or addition) SF <br /> BUILDING TYPE: ❑ SFR-DETACHED ❑ SFR-ATTACHED ❑ DUPLEX ►czMULTI-FAMILY-#OF UNITS: ❑ COMMERCIAL <br /> USE OF BUILDING: (,/rVf( /Erl�S/AGiv7r <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK: $ <br /> NUMBER OF DEVICES (if low voltage): <br /> FIRE ALARM? ❑YES C3NO <br /> ASSOCIATED BUILDING PERMIT# (if applicable): <br /> DESCRIPTION OF WORK: IR s PL-NC.F— S' (� <br /> CONTACT INFORMATION <br /> OWNER NAME: TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET { 3 Lt X Lf -- " l L. LV <br /> CITY bm Q w`'Y STATE W 71P 949 C�AQS <br /> OWNER PHONE: 2 2C?-- (Q OWNER EMAIL: <br /> CONTRACTOR NAME: L(71� <br /> CONTRACTOR ADDRESS: STREET 3:31 -grf OA:—C <br /> CITY —:-i(—P, ,\� STATE ZIP <br /> CONTRACTOR PHONE: -d -2:5 3 ' wo CONTRACTOR EMAIL: G -1, G<QttC <br /> CONTRACTOR LIC.#(REQUIRED): l y_�L C, }j CITY OF EVERETT BUSINESS LIC.#(REQUIRED): <br /> PRIMARY CONTACT: ❑ OWNER CONTRACTOR ❑ OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: ef A 6 3C 1P <br /> lx-� t tc-a Nk e VlN CONTACT EMAIL: S i�- <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 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 /> Owner/Au orized Ag Date (Revised 9/23/2016) <br /> v' <br />