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0 • <br /> 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 SITE INFORMATION <br /> PROJECT ADDRESS: r g( R -15-v 9 gZ0 <br /> BUILDING AREA(if residential, new construction, remodel, or addition) SF <br /> BUILDING TYPE: ❑ SFR-DETACHED ❑ SFR-ATTACHED ❑ DUPLEX ❑ MULTI-FAMILY-#OF UNITS: KCOMMERCIAL <br /> USE OF BUILDING: 5 <br /> EL CAL APPLICA ON INFORMATION <br /> CONTRACT PRICE OF WORK: $ <br /> NUMBER OF DEVICES (if low volt <br /> FIRE ALARM? ❑YES XNO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIPTION OF WORK: T-0 <br /> S 'St <br /> ern- c4u-(,- co.'Jvow <br /> CONTACT INFORMATION <br /> OWNER NAME: TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET $w 3 CA-.1Pc? 13GD&- <br /> CITY ' V' STATE ZIP Sto <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: 56a-AD-1" L <br /> CONTRACTOR ADDRESS: STREET �j �j tj NQ <br /> CITY STATE ZIP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: al✓ , b <br /> CONTRACTOR LIC.#(REQUIRED): CITY OF EVERETT BUSINESS LIC.#(R UIRED): <br /> PRIMARY CONTACT: ❑OWNER CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: 6kZCj- i7 Z,� I <br /> CONTACT EMAIL: d� � ^ <br /> AGREEMENT:1 hereby certify that I have read and examined this application and know the same to&true and correct. All p ovisions of law4 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 I <br /> comply with the State Contractors Law 18.27 RCW and 296.200 WAC. <br /> City of Everett Official Use Only <br /> PERMIT# <br /> (AQ 2� 1 1'm I I +' E �L09 -- 23(-o <br /> Owner/ ho ed Agent gnature Date I (Revised 9/23/2016) <br />