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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: � <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 /> [USEF BUILDING: <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK: $ <br /> NUMBER OF DEVICES (if low voltage): <br /> FIRE ALARM? ❑YES 1E0 <br /> ASSOCIATED BUILDING PERMIT#(if applicable):Z <br /> DESCRIPTION OF WORK: <br /> CONTACT INFORMATION <br /> OWNER NAME `/��/ �" TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET <br /> CITY STATE ZIP <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: / �� C <br /> CONTRACTOR ADDRESS: STREET <br /> CITY STATE ZIP C' <br /> CONTRACTOR PHONE: `7– ONTRACTOR EMAIL: <br /> CONTRACTOR LIC.#(REQUIRED): �/� _ L CITY OF EVERETT BUSINESS LIC.#(REQUIRED) :] <br /> PRIMARY CONTACT: ❑OWNER CONTRACTOR ❑ OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: _ _ v <br /> v CONTACT EMAIL: — 7 <br /> AGREEMENT:1 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 /> CZ PERMIT# <br /> /b - /-l � E <br /> Owner/Authorized Agent Signature Date (Revised 9/23/2016) <br />