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• <br /> ELECTRICAL PERMIT APPICATION <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: �3( 3�-� Ve—fe-E{ ;Lo .7 <br /> BUILDING AREA(if residential, new construction, remodel,or addition) •_)'Si oc?D SF <br /> BUILDING TYPE: ❑ SFR-DETACHED ❑ SFR-ATTACHED ❑ DUPLEX ❑ MULTI-FAMILY-#OF UNITS: CI COMMERCIAL <br /> USE OF BUILDING: I O�IM �kC <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK: $ U CJ CJC� <br /> NUMBER OF DEVICES (if low voltage): <br /> FIRE ALARM? ❑YES ❑ NO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIPTION OF WORK: �(\tht e h\ CA-A-3, <br /> CONTACT INFORMATION 1 , <br /> OWNER NAME: TENANT NAME(If Commercial): �ec. T- <br /> OWNER MAILING ADDRESS: STREET <br /> CITY STATE ZIP <br /> OWNER PHONE: CC OWNER EMAIL: <br /> CONTRACTOR NAME: �(fC 1 L Ln L <br /> CONTRACTOR ADDRESS: STREET <br /> crrY Viepi I- STATE - ZIP �'� (_. 1 <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> CONTRACTOR LIC.#(REQUIRED): C7LSr_iV> lq ?i rC_ CITY OF EVERETT BUSINESS LIC.#(REQUIRED): l� <br /> PRIMARY CONTACT: ❑OWNER ❑ CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: 2 S � 7 Y� <br /> ( �M� �� CONTACT EMAIL: 5 f , t' [x s <br /> AGREEMENT:I hereby certify that I have read and examined this application and know the same to be true and cotrekt. 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 1 <br /> comply with the State Contractors Law 18.27 PCW and 296.200 WAC. <br /> City of Everett Official Use Only <br /> - PERMIT# <br /> Owner/Aut/ffb/sized Agent Signature Date (Revised 9/23/2016) <br /> V <br />