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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 FAX 425-257-8857 1 (E) everetteps@everettwa.gov I www.everettwa.gov/permits <br /> PROJECT SITE INFORMATION <br /> PROJECT ADDRESS: ��` Ae j —L,.P- <br /> BUILDING AREA(if residential, new construction, remodel, or addition) SF <br /> BUILDING TYPE: ❑ SFR-DETACHED ❑ SFR-ATTACHED A DUPLEX ❑ MULTI-FAMILY-#OF UNITS: ❑ COMMERCIAL <br /> USE OF BUILDING: ' <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK: $ <br /> NUMBER OF DEVICES (if low voltage): <br /> FIRE ALARM? ❑YES N <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIPTION OF WORK: <br /> CONTACT INFORMATION <br /> OWNER NAME: TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET ' � L., <br /> CITY ' Z. '•j•'C A Ci STATE ZI l <br /> OWNER PHONE: a r/6, <br /> F_ <br /> OWNER <br /> .rIV <br /> CONTRACTORNAME: C� �+ <br /> CONTRACTOR ADDRESS: STREET 7 / <br /> CITY '` I� STATE .[.Y ZIP ! <br /> CONTRACTOR PHONE: -` - e q C CONTRACTOR EMAIL: <br /> CONTRACTOR LIC.#(REQUIRED):j/''( �,5 (% 420 CITY OF EVERETT BUSINESS LIC.#(REQ IRED <br /> PRIMARY CONTACT: ❑OWNER CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: <br /> /"dC f✓I75p CONTACT EMAIL: <br /> AGREEMENT.l 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 /> --- PERMIT# <br /> O er/A41thorized Agent Signature Date (Revised 9/23/2016) <br />