Laserfiche WebLink
J.ECTRICAL PERMIT AFL ICATION <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: o 2 7 <br /> BUILDING AREA(if residential, new construction, remodel, or addition) i >�°u SF <br /> BUILDING TYPE: ElSFR-DETACHEDErr SFR-ATTACHED ❑ DUPLEX ❑ MULTI-FAMILY-#OF UNITS: ❑ COMMERCIAL <br /> USE OF BUILDING: <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK: $ <br /> NUMBER OF DEVICES (if low voltage): <br /> FIRE ALARM? ❑ YES ❑ NO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIPTION OF WORK: 0--5 c-,-7C /X fi ,2 <br /> �rti t <br /> CONTACT INFORMATION <br /> OWNER NAME: /11-17 S TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET <br /> CITY r STATE .� ZIP 9 F-Z O <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: <br /> CONTRACTOR ADDRESS: STREET <br /> CITY STATE ZIP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> CONTRACTOR LIC.#(REQUIRED): CITY OF EVERETT BUSINESS LIC.#(REQUIRED): <br /> PRIMARY CONTACT: OWNER ❑ CONTRACTOR ❑ OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: Z�'2 SS ��— 7-5 <br /> Y7 �� CONTACT EMAIL: / <br /> AGREEMENT:T hereby certify that I have read and examined this application and know the same to be true and correct All provisions of fWws and ordinances governing this <br /> type 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/ <br /> comply with the State Contractors Law 18.27 RCW and 296.200 WAC. <br /> City of Everett Official Use Only <br /> FEE <br /> UU <br /> PERMIT# <br /> Ow er/Authorized Age Signature Date (Revised 10/12/2015) <br />