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• 0 <br /> ELECTRICAL PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT,WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 I (E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> PROJECT SITE INFORMATION <br /> PROJECT ADDRESS: G �;} �`� _rte• <br /> BUILDING AREA(if residential,new construction, remodel,or ad tion) SF <br /> BUILDING TYPE: ❑SFR-DETACHED ❑ SFR-ATTACHED ❑ DUPLEX 0 MULTI-FAMILY-#OF UNITS: XC OMMERCIAL <br /> USE OF BUILDING: ;` J <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 a licable : _ <br /> DESCRIPTION OF WORK: 'UN ,w -V1 <br /> CONTACT INFORMATION <br /> OWNER NAME: �,- TENANT NAME if Commercial): <br /> OWNER MAILING ADDRESS: STREET4�5 ,26 V4 j �}[ <br /> CITY --✓�.1'C/ STATE ZIP {U Z.l.� <br /> OWNER PHONE: ff OWNER EMAIL: <br /> CONTRACTOR NAME: <br /> CONTRACTOR ADDRESS: STREET so 5) Z2UVV) st <br /> CITY STATE ZIP <br /> CONTRACTOR PHONE: CON`T`RACTOR EMAIL: � �° = � e Z ft'Cc• 'o <br /> CONTRACTOR LIC.#(REQUIRED) � Vv CITY OF EVERETT BUSINESS LIC.#(REQUIRE:D)5-35,5(.,.) o <br /> PRIMARY CONTACT: ❑OWNERONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: �� — — <br /> CONTACT EMAI o- 6 <br /> AGREEMENT.Thereby 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 ` 1 <br /> type of work wit/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 i <br /> comply with the State Contractors Law 18.27 RCW and 286.200 WAC, <br /> City of Everett Official Use Only <br /> FEE ,...�...a. <br /> 7�D � <br /> PERMIT# <br /> Owner/ uthorized Agent Signature Date (Revised 10/1212015) <br /> I <br /> TDa vva L.a n-z._ <br />