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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)evetrettePSt everettwa.gov j www.everettwa-gov/permfts <br /> 2j IPROJECT SITE INFORMATION <br /> PROJECT ADDRESS. 4kA& <br /> BUILDING AREA(if residential,new constriction,remodel,or addition) SF <br /> BUILDING TYPE: 13 SFR-DETACHED ❑SFR-ATTACHED CI DUPLEX CI MULTI-FAMILY-#OF UNITS: I Ct)MMERCIAL <br /> USE OF BUILDING: = .. Spec u -T-S v/z,- <br /> ELECTRICAL <br /> —T I L PLICA I INFORMATION <br /> CONTRACT PRICE OF ORIS. <br /> NUMBER OF DEVICES if low voltage): <br /> FIRE ALARM? C1 YES C�fN0 <br /> ASSOCIATED BUILDING PERMIT if applicable): <br /> DESCRIPTION OF WORK: <br /> CONTACT INFORMATION <br /> OY�NE�fi PVAME: TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: ST-BEET,''j,,^^'yz` <br /> CITY SriM1SE �P'✓`V j ZIP <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: <br /> CONTRACTOR ADDRESS: STPXET >� ' (( CJ 7— <br /> My l6 sr�� <br /> CONTRACTOR PHONE: � ' �� �2CO,NTPACTOR EMAIL: <br /> : tt c' <br /> CONTRACTOR LIC.#{REQUIRED}: C,i C a .j LCITY OF EVERETT BUSINESS LIC.#(REQUIRED): <br /> PRIMARY CONTACT: .. Q OWNER EI-CONTRACTOR ❑OTHER(Please Specify) <br /> CS?NTACT NAME: rN �. CONTACT PHONE. ! . <br /> PF <br /> / CONTACT EMAIL: <br /> AGt?EFAAEtVT,Thereby certify that i have read and examined this application and Rdaow the same to be true and correct. All provisions of laws and ordinances governing this <br /> type of work will 6e cornpieled whether specked herein or not. The granting of a permit does not presuma 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 Ism authorized by the owner of this property to perform the work for which application is made aiO t <br /> comply with the State Contractors Law 18.27 RCW and 296,200 WAC. <br /> City of Everett Official Use Only <br /> FEE .�.�.'......... <br /> PERMIT# <br /> CINlnertAuthrrized bent Signature pate (Revised 7011212015) <br />