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i 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 /> PROJECT SITE INFORMATION <br /> PROJECT ADDRESS: jwcl C-edar <br /> BUILDING AREA(if residential, new construction, remodel,or addition) SF <br /> BUILDING TYPE: ❑ SFR-DETACHED ❑SFR-ATTACHED ❑ DUPLEX ❑ MULTI-FAMILY-#OF UNITS: ACOMMERCIAL <br /> USE OF BUILDING: <br /> ELECTRICAL APPLICATION INFORMATION <br /> ,ONTFZACT PRICE OF WORK: $ <br /> NUMBER OF DEVICES (if low voltage): Z r2 e S, S c o,�c P S s yr S <br /> FIRE ALARM? ❑YES RNO <br /> ASSOCIATED BUILDING PERMIT# if applicable): <br /> DESCRIPTION OF WORK: Login t up, <br /> D 'rIdCS, ca(\ceSStcr-S <br /> CONTACT INFORMATION <br /> OWNER NAME: aoi S C SCCc� TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET VIC.:� f �Ll <br /> CITYtyc("161 STATE V ZIP 72/7 <br /> OWNER PHONE: 15119() LOU, <br /> I �� OWNER EMAIL: cu 6c/k-(_"jm HEEOb-IA-at I ,�n4l <br /> CONTRACTOR NAME: <br /> CONTRACTOR ADDRESS: STREET <br /> CITY STATE ZIP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> CONTRACTOR LIC.#(REQUIRED): CITY OF EVERETT BUSINESS LIC.#(REQUIRED): <br /> PRIMARY CONTACT: P]OWNER ❑CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: 3(-p <br /> CONTACT EMAIL: <br /> anujn el Nl SYYII 'l k' ll I <br /> AGREEMENT.I 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 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 296.200 WAC. <br /> City of Everett Official Use Only <br /> PERMIT# <br /> Owner/Authoriz d Agent Signature Date (Revised 9/23/2016) <br />