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�ECTRICAL PERMIT AP�ICATI4N <br /> CITY dF EVERETT PERMIT SERVICES <br /> 320Q CEDAR STREET, EVERETT,WA 98201 <br /> {P}425-257-8810 1 FAX 425-257-8857 � (E}everetteps@everettwa.gov( www.everettwa.gav/permits <br /> Pl���#E�T�!'�#NF4RNfAT1F#�i '; <br /> _ <br /> PROJECT ADDRESS: ' � �} �h ' � �b <br /> BUILDING AREA(if residen6al,new nstruction,remodel,or addition) � � SF <br /> BUILDING TYPE: 0 SFR-DETACHED I�SFR-ATTACHED ❑DUPLEX MULTI-FAMILY-#OF UNITS: O COMMERCIAL <br /> USE OF BUIl.DING: � � <br /> : EI.EC?RIC�kL APPLtCAT�ON-INFORMATION <br /> CONTRACT PRICE OF WORK:$ <br /> NUMBER OF DEVICES if low vofta e : <br /> FIRE ALARMZ ❑YES NO <br /> ASSOCIATED BUILDING PERMIT# if a ticable : <br /> __ __._ _ <br /> DESCRIPT.ION_QE.WORK: 3� �L.SCQ . . ''�, � � <br /> _ � $�� � � <br /> �� �� �} � <br /> � <br /> co�rr����Far�M�T�o� , <br /> :_ : . _ <br /> OWNER NAME: � 1 Q. �. TEI�ANT NAME(If Commera[aq: <br /> OWNER MAILING ADDRESS: s-rReer Q S� � � �, <br /> CIT'( STATE ZIP � <br /> OWNER PHONE: � � OWNER EMAIL: <br /> __. <br /> __ ._ _ ___ . <br /> _ <br /> • � . <br /> CONTRACTOR NAME: � ( <br /> CONTRACTOR ADDRESS: srReer ` �, �.��1n � ` <br /> � CIT1 , STATE ZIP . <br /> CONTRACTOR PHONE: �� CONTRACTOR EMAIL: • ` \ � � <br /> CONTRACTOR UC.#(REQUiRED): � CITY OF EV BUSINES$LIC.#(REQUIRED)� <br /> _ _. _._ _ <br /> PRIMARY CONTACT: ❑OWNER �ONTRACTOR ❑OTHER{Please Speafy) <br /> CONTACT NAME: CONTACT PHONE; � Q�` <br /> � CONTACT EMAIL: <br /> AGREEMENT.•T hereby ce at t have read and examined this appilcetion and know the same to be tme and co�rect A!I provisions of/aws and orrlinances goveming this <br /> type of work wilt be compfeted whether specified herein or not. The granting of a permitdoes not prasume to gnre aufhority to violate or cancel the provisions of any other state or <br /> local law regufaGng construction or tfie performance of consbuction. That l am authorized by the owner of this prnperly to perform fhe work for which application is made and l <br /> comply wifh the 5tate Contractors taw 18.27 RCW and 296.200 WAC. <br /> City of Evertstt Official Use Onty <br /> FEE � <br /> � ��� � . . <br /> PERMIT# <br /> o► �-� E � � D � <br /> Owner! Signature Date (Revised 10/122015) <br />