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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 1 FAX 425-257-8857 1 (E) everetteps@everettwa.gov I vwvw.everettwa.gov/permits <br /> PROJECT SITE INFORMATION <br /> PROJECT ADDRESS: <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: e--"1 C�P.,v <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK: $ j <br /> NUMBER OF DEVICES (if low voltage): <br /> FIRE ALARM? ❑YES ❑ NO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIPTION OF WORK: <br /> n <br /> CONTACT INFORMATION <br /> OWNER NAME: S TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET C Q <br /> CITY .J..3"oQ STATE ZIP <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: (qhs J 1J p ^ r <br /> CONTRACTOR ADDRESS: STREET 0 R <br /> CITY STATE �.. ZIP C <br /> CONTRACTOR PHONE:C 451-5, j 3 CONTRACTOR EMAIL: •�, jv <br /> CONTRACTOR LIC.#(REQUIRED): c G.- CITY OF EVERETT BUSINESS LIC.#(REQUIRED): 0S 01 61S <br /> PRIMARY CONTACT: ❑OWNER CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: 'l� 5. i1- � i <br /> cas5I�j CONTACT EMAIL: <br /> AGREEMENT./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 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 /> r <br /> PERMIT# <br /> ° D ~' —7 E ` D� `• Y <br /> Owner/Ruth rized Agent Signature Date (Revised 9/23/2016) <br />