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E[.ECTRICAL PERMIT APPLICATIC�N <br /> CiTY OF EVERETT PERMIT SERVICES <br /> 32Q�CEDAR STREET, EVERETT,WA 98201 <br /> (P)425•257-8810 � FAX 425-257-8857 � (E)everetteps@everettwa.gov� www.everettwa.gov/permits <br /> > PROJEC7 SITE INFORMATION <br /> n> � <br /> PROJECTADDRESS: ��L "'�� � <br /> BUILDING AREA(if residential,new construction,remodel,or addition) SF <br /> BUILDING TYPE: SFR-DETACHED ❑SFR-ATTACHED ❑ DUPLEX ❑MULTI-FAMILY-#OF UNI7S: ❑CQMMERCIAL <br /> USE OF BUILDING: � � <br /> ELECTRICAL APPLICATION INFORMATION ` <br /> .. ,. . <br /> CONTRACT PRICE OF WORK:$ �� <br /> NUMBER OF DEVICES if low volta e : � <br /> FtRE ALARM? ❑YES ❑NO <br /> ASSOCIATED BUILDMG PERMIT# if a licable : <br /> DESCRIPTION OF WORK: .,�.7�. ''r" <br /> CONTACT INFORMATION <br /> _. .. _ ,..�. . <br /> OWNER NAME: `� � TENANT NAME if Commercial : <br /> OWNER MAILING ADDRESS: srn�er ��"� e. <br /> � �Y STATE 1/Y � ZIP <br /> OWNER PHONE:��� -� � OWNER EMAIL: �" - <br /> _,. _ <br /> CONTRACTOR NAME: � � � � <br /> CONTRACTOR ADDRESS: srReer Z ��,. 1�� <br /> CI71' �� STATE Z�P � � <br /> GONTRACTOR PHONE:�'6�-J • . . CONTRACTOR EMAIL: � /� d ��,�(� <br /> CONTRACTOR LIC.#(REQUIRED): ,�j C17Y OF EVERETT BUSWESS UC.#REQUIRED: <� <br /> .._. . , <br /> PRIMARY GONTACT: ❑OWNER NTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE:�-'�,'� � tU� (.,�� <br /> �`c...�l���4�'" CONTACT EMAIL: `�.�►,1 c��C"� �1'�v�t.�%��4 �G�� �e.a�v ] <br /> �.�'1`F <br /> AGREEMENT.•1 hereby cartlfy that/heve!ead and examined thls applieatfon and know the same to be true and correat. All provlsions of/aws and oMlnances govemirtg thls type <br /> of work wi/l be campleted whether specifled herein or not The graniing of a pemtit does not presume to give authorky to violate or cance/the provlsions of any other state or <br /> locaf law regulating construction or the performance of constructlon. That I am authorized by the owner of this property to pedorm fhe work far w61ch application ls made and/ <br /> comply with the State Contractors Law 18.27 RCW and 296.200 WAC. <br /> City of Everett Official Use Onfy <br /> PERMIT# <br /> � � E ���� � � � c <br /> n r/ t rized A e ignatur Dat (Revised 9/23/2018) <br />