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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 ADDRESS: ( 0 / " 10L W <br />BUILDING AREA (if residential, new construction, remodel, or addiRlon) SF <br />BUILDING TYPE: 11 VSFR-DETACHED ❑ SFR-ATTACHED ❑ DUPLEX ❑ MULTI FAMILY # OF UNITS <br />USE OF BUILDING: <br />ELEC i''RIC <br />CONTRACT PRICE OF WORK: $ <br />NUMBER OF DEVICES (if low voltage): <br />FIRE ALARM? ❑ YES <br />ASSOCIATED BUILDING PERMIT # (if armlicablel <br />❑ COMMERCIAL <br />+f+tti t- Ad' IN C � . <br />OWNER NAME: <br />TENANT NAME If Commercial): <br />OWNER MAILING ADDRESS: sTREET <br />G <br />crry <br />OWNER PHONE: 2, <br />STATE ZIP (d <br />OWNER EMAIL: <br />CONTRACTOR NAME: <br />CONTRACTOR ADDRESS: STREET <br />ILiI W0 <br />CITY <br />CONTRACTOR PHONE: �{ <br />STATER" ZIP' 20 <br />CONTRACTOR EMAIL: rn <br />CONTRACTOR LIC. #(REQUIRED}: i <br />_ <br />CITY OF EVERETT BUSINESS LIC. #(REQUIRED -.- <br />PRIMARY CONTACT: ❑ OWNER CONTRACTOR ❑ OTHER (Please Specify) <br />CONTACT NAME: <br />CONTACT PHONE:� <br />Vf(e <br />CONTACT EMAIL: _ <br />r t1c Etti - Cotry) <br />AGREEMENT: I hereby certify that I have read and ara—,—i i,%— <br />ing <br />Of worK will be completed whether specified herein or not. The granting of a permit does not presume to give authority to vio aons te or cancel the provisions of any other�statehis ortypa <br />local law regulating construction or the performance of construction. That lam 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 />Owner/Author(zed Agent Signature Dale <br />City of EvereH Official Use Only <br />PERMIT # <br />E <br />(Revised 912312016) <br />