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� • <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 � (E) everetteps@everettwa.gov � www.everettwa.gov/permits <br /> PROJECT SITE INFORMATION <br /> PROJECT ADDRESS: 2 ~ �J �ry Wav' . L�l� , L V e�L ( C/ �jO� <br /> BUILDING AREA(if residential, new construction, remodel, or addition) SF <br /> BUILDING TYPE: ❑ SFR-DETACHED ❑ SFR-AlTACHED ❑ DUPLEX �MULTI-FAMILY-#OF UNITS: ❑ COMMERCIAL <br /> USE OF BUILDING: J� �-� �y� <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK: $ (�� <br /> NUMBER OF DEVICES (if low voltage): <br /> FIRE ALARM? �.YES ❑ NO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIPTION OF WORK: U S �v�t� ��" E'C" o✓ <br /> CONTACT INFORMATION <br /> OWNER NAME:1�� ��1 TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: sTREET <br /> CITY STATE ZIP <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: {r\ JC (�,I � P.G' Y I C <br /> CONTRACTOR ADDRESS: sTReer Z Z U � �. �e0{/-' E� � <br /> ci7v Q(l�yY1Gi srnTE � ziP �"�O L <br /> CONTRACTOR PHONE: Z ��'Z U"bC��17 CONTRACTOR EMAIL: <br /> CONTRACTOR LIC.#(REQUIRED): � � CITY OF EVERETT BUSWESS LIC.#(REQUIRED): <br /> PRIMARY CONTACT: ❑OWNER �CONTRACTOR ❑ OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: ���3.-Z��.� �p�.! <br /> G E� , �( ��l CONTACT EMAIL: <br /> AGREEMENT.I hereby certrfy tha I have read and examined this application and know the same to be true and correct. All provisrons of laws and ordinances governing this type <br /> of work will be completed wheth r 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 pertorm 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 On/y <br /> PERMIT# <br /> �� � - �� E I� 0�1 � b��l <br /> Owner/Authorized Agent S' ature Date (Revised 9/23/2016) <br />