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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 /> 'PROJECT SITE INFORMATION '' <br /> PROJECT ADDRESS: � ��7�..� �I��, <br /> BUILDING AREA(if residential, new construction, remodel, or addition) SF <br /> BUILDING TYPE: ❑SFR-DETACHED ❑SFR-ATTACHED ❑ DUPLEX ❑ MULTI-FAMILY-#OF UNITS: ❑COMMERCIAL <br /> USE OF BUILDING: � <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK: $ OC$�'� <br /> NUMBER OF DEVICES (if low voltage): <br /> FIRE ALARM? ❑YES ❑NO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIPTION OF WORK: „�fYIB�G �. �PZ. �`' (/�, �1�'G/ f1 � <br /> � �..�.� f9 � �' <br /> ' ��.� � L fk�� <br /> CONTACT INFORMATION <br /> OWNER NAME: l�� ��VCJt�'�i, T '� p I�;/J�� TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: srReeT �� L. �`G. <br /> CITY � � STATE ZIP e���� <br /> OWNER PHONE:�,�. O��� OWNER EMAIL: <br /> CONTRACTOR NAME: � L�-l�� �J ~� I� ����C,� <br /> CONTRACTOR ADDRESS: srREer <br /> r <br /> CITY �^. ' STATE ZIP <br /> CONTRACTOR PHONE: �- CONTRACTOR EMAIL: <br /> CONTRACTOR LIC.#(REQUIRED): (.� � /' � CITY OF EVERETT BUSINESS LIC.#(REQUIRED):��(�� � <br /> PRIMARY CONTACT: ❑OWNER ❑CONTRACTOR ❑OTHER(Please Specify) <br /> CONT�AME: CONTACT PHONE: } �� � �+ ` <br /> �� i`�� Eo!''�� <br /> £ r�, o �ES �a� '� CONTACT EMAIL: <br /> AGREEMENT.�I hereby certify that I have read and examined this applicafion and know the same to 6e true and correct All provisions of laws and ordinances governing this type <br /> of work will be compieted whether specified herein or not. The granting of a permit does not presume to give aufhority to violate or cancel 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 /> p' t?0�`� <br /> 9 <br /> y City of Everett Official Use Only <br /> ' PERMIT# <br /> . �_�� � E W I�; ��1� D�S <br /> Ow thorized Agent Signature ate (Revised 9/23/2016) <br /> ����� <br />