Laserfiche WebLink
� � <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� -�Xl N�rT'�'�� <br /> BUILDING AREA(if residential, new construction, remodel, or addition) SF <br /> BUILDING TYPE: ❑ SFR-DETACHED ❑ SFR-ATTACHED I,�DUPLEX ❑ MULTI-FAMILY-#OF UNITS: ❑ COMMERCIAL <br /> USE OF BUILDING: <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK: $ i G (� <br /> NUMBER OF DEVICES (if low voltage): <br /> FIRE ALARM? ❑YES ❑ NO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIPTIONOFWORK: I.�i ��[ ��1=1n) i��'���`• ,C'�� h��1 � � '�-'ti�lC- <br /> CONTACT INFORMATION <br /> OWNER NAME: �i, �� TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: sTReeT <br /> CITY STATE ZIP <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTORNAME: �i_).�,�JY'�� 1 �L„��C��1�, �/�� �, <br /> CONTRACTOR ADDRESS: srReer �I � � L,� ,I,�-� S� IZJ(/�) <br /> a1v �T� � � ��, <br /> P,J�/�C10 sTnre J ziP �' '� <br /> CONTRACTOR PHONE: ��. : �Q� ? �~� CONTRACTOR EMAIL: ��� � �!� .�t'��"�� (1�' ����� ��� <br /> CONTRACTOR LIC.#(REQUIRED): � � ,� ��i� � !���� IC�1.. CITY OF EVERETT BUSINESS LIC.#(REQUIRED)• �"�,��� 2 ;; <br /> PRIMARY CONTACT: ❑ OWNER �(CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: U^,� �� ^ J"� �Q <br /> �`=- CONTACT EMAIL: <br /> AGREEMENT:1 hereby 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 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 l <br /> comply with the State Contractors Law 18.27 RCW and 296.200 WAC. <br /> � City of Everett Official Use Only <br /> PERMIT# <br /> �������-��� � �U l�.��; 2; .ZC]i�� � `'�� � � �� <br /> � J <br /> Owner/Authorized Agent Signature Date (Revised 9/23/2016) <br />