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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: D b In ST_ <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 /> USE OF BUILDING: AA_, <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK: $ 'U,v" <br /> NUMBER OF DEVICES (if low voltage): <br /> FIRE ALARM? ❑YES ❑ NO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): j <br /> DESCRIPTION OF WORK: v A^, Vi e- c l n� �� civ► <br /> k-'v1Z�K v 4-- 'E- -vim <br /> CONTACT INFORMATION <br /> OWNER NAME: C k_.nt —e Y1143 TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET <br /> CITY STATE ZIP <br /> OWNER PHONE: "I r�cj C� y ' 1 OWNER EMAIL: <br /> CONTRACTOR NAME: ��n� G` �Vz� ` arc �'�!Z C�QGf <br /> CONTRACTOR ADDRESS: STREET �J(� <br /> CITY ��J(:.�'T C STATE ZIP `O j <br /> CONTRACTOR PHONE: — (U -O`/ CONTRACTOR EMAIL: com Nx� <br /> CONTRACTOR LIC.#(REQUIRED): ) 'k-g <br /> k 1 U V CJ CITY OF EVERETT BUSINESS LIC.#(REQUIRED): OL-I -i <br /> PRIMARY CONTACT: OWNER ❑ CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: 1 CONTACT PHONE: <br /> dkav- CONTACT EMAIL: <br /> AGREEMENT-/hereby certify that/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 15.27 RCW and 296.200 WAC. <br /> City of Everett Official Use Only <br /> PERMIT# <br /> C4 Elm - 2ol <br /> ner/ ed Agent Signature Date (Revised 9/23/2016) <br />