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ECTRICAL PERMIT AP�.ICATION <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 /> PR4JECT SITE INFQRMATION <br /> PROJECT ADDRESS: -� ' ` 1-� <br /> BUILDING AREA(if residential,new construction,remodel,or addition) SF <br /> BUILDING TYPE: o SFR-DETACHED o SFR-ATTACHED a DUPLEX o MULTI-FAMILY-#OF UNITS: COMMERCIAL <br /> USE OF BUILDING: � (� �,�,� `��\� � � <br /> 'ELECTRICAL APPLICATION;iNFQRMATION <br /> CONTRACT PRfCE OF WORK:$ <br /> NUMBER OF DEVICES if low volta e : � <br /> FIRE ALARM? YES o NO <br /> ASSOCIATED BUILDING PERMIT#(if a licable : <br /> DESCRIPTION UF WORK: � ` � � 1",-� � 6��`\v� <br /> � <br /> ��l �� � ��7� � <br /> CONTACT INFORMATIDN <br /> OWNER NANAE: TENANT NAME If Commerciaf: �\ r� <br /> OWNER MAILING ADDR�SS: srRe�r t�� � �i� �"�`` �r <br /> �iTM STATE ziPq, <br /> OWNER PHONE: �d�-J � OWNER EMAIL: <br /> CONTRACTOR NAME: �'Cj'� CJ�� `� <br /> CONTRACTOR ADDRESS: STREET ��� � � <br /> CI7Y i ��J STATE � ZIP � " <br /> CONTRACTOR PHONE: ��.�J�3`� CONTRACTOR EMAIL: <br /> CONTRACTOR LIG.#(REQUIRED}:���'P�,�����E-e� CITY OF EVERE7T BUSINESS LIC.#(REQUIRED):���?�� <br /> PRIMARY CONTACT: o OWNER o CONTRACTOR ,�OTHER(Please Specify) ���� <br /> CONTAGT NAME���,�� 1 ��� CONTACT PHONE: (�� �, �� <br /> �J�- \ <br /> CONTACT EMAIL: " ' �,�P`�\�V'1��1(� ' <br /> AGREEMENT.•I hereby certify that/have read and examined this application and know the same to be true and correct. AI!provisiorts of laws and ordinances goveming this type <br /> of work wilf be compteted whether speci�ed hereitt or not. The granting of a permit does not presui»e to give authority to vio/ate or cance/the provisions of any other state or <br /> local law regu/ating construction or the performance of construction. That I am authorfzed by the owner of this property to periorm the work for which application is made and I <br /> compry with the State Contractors Law 18.27 RCW and 296.200 WAC. <br /> City of Everett�cial tJse On/y <br /> ��� <br /> PERMIT# <br /> ` �� E l�Dl"�� <br /> � l� I � � <br /> Qwner/Authorized Agent Slgnature Date (Revised 9/23/2016) <br /> � <br />