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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 � FAX 425-257-8857 � (E) everetteps@everettwa.gov� www.everettwa.gov/permits
<br /> �'������ � � PROJEGT SITE� NFORMATION � �°�� � �
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<br /> PROJECT ADDRESS: `6 1 � ��.
<br /> BUILDING AREA(if residential, new construction, remodel, or addition) SF
<br /> BUILDWG TYPE: ❑ SFR-DETACHED ❑SFR-AlTACHED ❑ DUPLEX ❑ MULTI-FAMILY-#OF UNITS: OMMERCIAL
<br /> USE OF BUILDING: ��R�j ��'1a-' �
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<br /> - _ .,; ELECTRICAL APPLICATION INFORMATION, ,
<br /> CONTRACT PRICE OF WORK: $ 1 ���
<br /> NUMBER OF DEVICES (if low volta e):
<br /> FIRE ALARM? ❑YES NO
<br /> ASSOCIATED BUILDtNG PERMIT#(if applicable :
<br /> DESCRIPTION OF WORK: � �1f q p,S' I� � °� �,,F=
<br /> ' ���"�' �` E CONTACT�INIF�lRMATION s ���� ����
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<br /> OWNER NAME. � � TENANT NAME(If Commercial): � � � '�'►4� (��
<br /> OWNER MAILING ADDRESS: sTReeT 0(p � 2 �� ''� �� �-i/�
<br /> CITY � ''�y STATE ZIP
<br /> OWNER PHONE: OWNER EMAIL:
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<br /> CONTRACTOR NAME: � � r �/ I � 'e
<br /> CONTRACTOR ADDRESS: srReer
<br /> CITY STATE � Y T� ZIP 9 .
<br /> CONTRACTOR PHONE: �`'�� ` r(? � CONTRACTOR EMAIL: � �¢�
<br /> CONTRACTOR LIC.#(REQUIRED): ''G�" I "= '� (� �� CITY OF E ERETT BUSINESS LIC.#(REQUIRED): G� G ��
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<br /> PRIMARY CONTACT: ❑OWNER �ONTRACTOR ❑OTHER(Please Specify)
<br /> CONTACT AME: CONTACT PHONE: �""_ , � � ��
<br /> i� CONTACT EMAIL: (� � �
<br /> AGREEMENT.�I hereby certify that l have read and examined this application and know the same to be true and correct. All provisio 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 1
<br /> comply with the State Contractors Law 18.27 RCW and 296.200 WAC.
<br /> City of Everett Official Use Only
<br /> PERMIT#
<br /> d� Ell���� �'� �D
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<br /> Ow orized Agent Signature Date (Revised 9/23/2016)
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