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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 /> n PROJECT SITE INFORMATION <br /> PROJECT ADDRESS: F 6` 6 � <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: <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK: $ -Z- 6V <br /> NUMBER OF DEVICES (if low voltage): <br /> FIRE ALARM? ❑YES ❑ NO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIPTION OF WORK: �L75!� "L> `moi ,(ti d"' / L <br /> CONTACT INFORMATION <br /> OWNER NAME: TENANT NAME(If Commercial): <br /> OWNER MAILING DDRESS: STREET � 7 <br /> CITY VV� STATE Lf J ZIP <br /> OWNER PHONE: // 7'��L� OWNER EMAIL: <br /> CONTRACTOR NAME: ?✓/ j% hC <br /> CONTRACTOR ADDRESS: STREET <br /> CITY ` �itSTATE ` ZIP <br /> CONTRACTOR PHONE: �f — 7/ � CONTRACTOR EMAIL: <br /> CONTRACTOR LIC.#(REQUIRED): ( " QG/6r'&TY OF EVERETT BUSINESS LIC.#(REQUI ED): 5 <br /> PRIMARY CONTACT: ❑OWNER CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: <br /> 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 laws 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 /> � <br /> PERMIT# <br /> �lAltx <br /> Owner/Authorize Agen Signature Date (Revised 10/12/2015) <br />