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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 /> PROJECTSITE INFORMATION <br /> \ A <br /> PROJECT ADDRESS: 91� Zj Z J 0 il�_L 5 L- <br /> BUILDINGAREA(if residential, new construction, remodel, or addition) SF <br /> BUILDING TYPE: ❑ SFR-DETACHED ❑ SFR-ATTACHED ❑ DUPLEX ❑ MULTI-FAMILY-#OF UNITS: OMMERCIAL <br /> USE OF BUILDING: V e t zinS <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK: $ �/'j Q <br /> NUMBER OF DEVICES (if low voltage): <br /> FIRE ALARM? ❑YES NO <br /> ASSOCIATED BUILDING PERMIT#(if ap licable): <br /> DESCRIPTION OF WORK: Iqn II�f <br /> CONTACT INFORMATION /� <br /> OWNER NAME: TENANT NAME(If Commercial): A If IL C�' <br /> OWNER MAILING ADDRESS: STREET <br /> / CITY STATE ZIP 47 MnI8 <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: _ Fell-etr &lstf�j <br /> CONTRACTOR ADDRESS: STREET CI <br /> CITY J A- STATE ZIP <br /> CONTRACTOR PHONE: ZS j5-^ l I I CONTRACTOR EMAIL: Ctl , <br /> CONTRACTOR LIC.#(REQUIRED): E E C.E a - 'C>3 CITY OF EVERETT BUSINESS LIC.#(REQUIRED): ( (a� <br /> PRIMARY CONTACT: ❑OWNER .'CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: r CONTACT PHONE: Z S 3` C�/ r t D 87 <br /> 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 18.27 RCW and 296.200 WAC. <br /> City of Everett Official Use Only <br /> PERMIT# <br /> Owner/Authorized Agent Signature Date (Revised 9/23/2016) <br />