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0 <br /> IPLECTRICAL 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: i <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: rl GfM d <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK: $ /__106111 <br /> NUMBER OF DEVICES (if low voltage): <br /> FIRE ALARM? ❑YES DINO <br /> ASSOCIATED BUILDING PERMIT#(if applicable).- <br /> DESCRIPTION <br /> pplicable):DESCRIPTION OF WORK: — rlyl MC4. 4r'r' <br /> Q' <br /> CONTACT INFORMATION <br /> OWNER NAME: + i e f, TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREJ O Z5� 4 1 Ave , I: <br /> CITY (r v pr[(J STATE ZIP `T- 0._,l <br /> OWNER PHONE: ,� y 6371 IOWNER EMAIL: <br /> CONTRACTOR NAME: <br /> CONTRACTOR ADDRESS: STREET p & <br /> CITY L p ICP �.i+ r V STATE tAj,4 ZIP Z<g <br /> CONTRACTOR PHONE: '/25-._35(7. 637/ CONTRACTOR EMAIL: ! 6L <br /> CONTRACTOR LIC.#(REQUIRED): qLl` CITY OF EVERETT BUSINESS LIC.#(REQUIRED): �Q <br /> PRIMARY CONTACT: ❑OWNER Ci"CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME CONTACT PHONE: g753 J I.�-q <br /> 637 <br /> {t 1 '� �/� CONTACT EMAIL: f <br /> AGREEMENT. T hereby certify that t have read and examined this application and know the same to be true and colrect, 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/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 /> FEE <br /> C <br /> PERMIT# <br /> Ow er/Authorized Agent Signature Date (Revised 10/12/2015) <br />