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�LECTRICAL 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@everetfinra.gov� www.everettwa.gov/permits <br /> _ �; ' ' ' ' PRO.lE4'1'SIT� ��1FORMA'�)ON` ' ' <br /> � _ _ .�_ .. �. . :. �. �.__ .� �. . . 1. w_: : __ <br /> PROJECT ADDRESS: � � <br /> BUILDING AREA(if residential,new construction, odel,or addition) SF <br /> BUILDING TYPE: ❑SFR-DETACHED ❑ SFR-ATTACHED ❑ DUPLEX ❑MULTI-FAMILY-#OF UNITS: OMMERCIAL <br /> USE OF BUILDING: y�,n,� � ,S �„ <br /> ,' ^� � ': f;��E�TRICA�,.APPL�GI�T�01� IN�'�iRM�►t"ION ;�°���� �r'� � � <br /> �,� � ��:..��, ��,_„�� rv� r �;� ,'u,��.� � �r. <br /> CONTRACT PRICE OF WORK: $ <br /> NUMBER OF DEVICES if low volta e : <br /> FIRE ALARM? ❑YES ❑NO <br /> ASSOCIATED BUILDING PERMIT# if applicable : <br /> DESCRIPTION OF WORK: � p� <br /> .-- s�.-6�2r- <br /> ' ' . < CON'TACY INFORMATION ` ' <br /> OWNER NAME: � TENANT NAME(If Commercial): '� i <br /> OWNER MAILING ADDRESS: sTReeT �� c� � <br /> CITY �/, /� STATE �W ZIP � <br /> OWNER PHONE: -� �j�'+,�" OWNER EMAIL: <br /> CONTRACTOR NAME: w� <br /> CONTRACTOR ADDRESS: sTReET '�" <br /> CITY STATE ZIP � <br /> CONTRACTOR PHONE: � � CONTRACTOR EMAIL: � .. <br /> CONTRACTOR LIC.#(REQUIRED): G CITY OF EVERETT BUSINESS LIC. EQU ED): <br /> PRIMARY CONTACT: ❑OWNER CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: ���^t �-�(,t'� t„� <br /> J. CONTACT EMAIL: � <br /> AGREEMENT:1 hereby certify that l have read and examined this application and know the same to be true and correct. All provisio s law ordinances gov ing this type <br /> of work will be completed whether specified herein or not The granting of a permit does not presume fo give authority to violate or el the provisions of any other state or <br /> local law regulating construction or the performance of construction. That 1 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 /> � �, ( � E I�o��- oa�' <br /> Owner/Aut orized Agent Signature Date (Revised 9/23/2016) <br />