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*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 (E) everetteps@everettwa.gov I www.everettwa.gov/permits <br /> PROJECT SITE INFORMATION <br /> PROJECT ADDRESS: <br /> BUILDING AREA(if residential, new construction, remodel, or addition) SF MJF <br /> BUILDING TYPE: ❑ SFR-DETACHED ❑SFR-ATTACHED ❑ DUPLEX ❑ MULTI-FAMILY-#OF UNITS: ❑COMMERCIAL <br /> !USEOFBUILDING: � �.ti <br /> TRIC APPLICATION INFORMATION <br /> CONTRACT PRICE OF WO <br /> NUMBER OF DEVICES (if 16 voltage):. 0 <br /> FIRE ALARM? ❑YES ® NO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIPTION OF WORK: Y-�A L <br /> CONTACT INFORMATION <br /> OWNER NAME: TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREEr <br /> CITY STATE ZIP <br /> OWNER PHONE: �zcJ'?��� oz) OWNER EMAIL:S�'� YY1C5 L•Q-0M <br /> CONTRACTOR NAME: S� <br /> CONTRACTOR ADDRESS. STREET <br /> CITY TE Zi <br /> CONTRACTOR PHONE: CONT TOR EMAIL: <br /> CONTRACTOR LIC.#(REQUIRED): CITY OF EVERETT BUS ESS LIC.#(REQUIRED): <br /> PRIMARY CONTACT: ❑OWNER ❑CO RACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: <br /> t � CONTACT EMAIL: <br /> AGREEMENT.'Thereby 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 <br /> type 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 /> FEE <br /> PERMIT# <br /> Owner/Authorized Agent Signature Date (Revised 10/1212015) <br />