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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 www.everettwa.gov/permits <br /> PROJECT SITE INFORMATION <br /> PROJECT ADDRESS: t Fh 't{__ <br /> BUILDING AREA(if residential, new construction, remodel,or addition) SF <br /> BUILDING TYPE: ❑ SFR-DETACHED ❑ SFR-ATTACHED ❑ DUPLEX ❑ MULTI-FAMILY-#OF UNITS: OMMERCIAL <br /> USE OF BUILDING: 0-m"—e-- <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK: CUO <br /> NUMBER OF DEVICES if low v Ita e): (p <br /> FIRE ALARM? ES ❑ NO <br /> ASSOCIATED BUILDING PERMIT# if applicable <br /> DESCRIPTION OF WORK: <br /> v <br /> O - O <br /> CONTACT INFORMATION <br /> OWNER NAME: TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET <br /> CITY STATE ZIP <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: <br /> CONTRACTOR ADDRESS: STREET ,ZS Wu q <br /> CITY STATE Aj A ZIP a <br /> CONTRACTOR PHONE:a 53 - S(i L -L O uY,� CONTRACTOR EMAIL: +} OLSen G,( <br /> CONTRACTOR LIC.#(REQUIRED):QL,. OA)F-VL3 ICITY OF EVERETT BUSINESS LIC.#(REQUIRED):044 �UaL <br /> PRIMARY CONTACT: ❑OWNER &CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE:oZ S 3. S(o <br /> CONTACT EMAIL: 44.AGREEMENT.I hereby certify that/halve read and examined this application and know the samVto be true an 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 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 RCW and 296.200 WAC. <br /> City of Everett Official Use Only <br /> PERMIT# <br /> s E777 <br /> Owner/ dthprized Agent Signature Date (Revised 9/23/2016) <br /> L <br />