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�LECTRICAL PERMIT AP�CATION <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 /> PROJEC'T SITE INFORMi4T10N =;; <br /> . _ ,. _ ,... �. . .. . . .. . <br /> PROJECT ADDRESS: �(�Z. " �` "` _ . . <br /> BUILDING AREA(if residential,new construction,remodel,or addition) SF <br /> BUILDING TYPE: ❑SFR-DETACHED ❑SFR-ATTACHED �DUPLEX ❑MULTI-FAMILY-#OF UNITS: OMMERCIAL <br /> USE OF BUILDING: - I - <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK: $ � <br /> NUMBER OF DEVICES if low volta e : � <br /> FIRE ALARM? ❑YES ❑NO <br /> ASSOCIATED BUILDING PERMIT# if a licable : <br /> DESCRIPTION OF WORK: 5 � 1 � � \ <br /> . ... . . . <br /> CONTACT INFORMATION <br /> OWNER NAME: G( � � 1,.� TENANT NAME(If Commercial):� � � � <br /> OWNER MAILING ADDRESS: s-rRee-r �r D �n <br /> CITY STATE ft ZIP � � ' <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: � <br /> CONTRACTOR ADDRESS: sTReer � Q� Si <br /> CITY STATE ,� ZIP Q �� <br /> CONTRACTOR PHONE: � - � —)�� CONTRACTOR EMAIL: � � � - <br /> CONTRACTOR LIC.#(REG2UIRED): �i � (���JZ 1�-fS CITY OF EVERETT BUSINESS LIC.#(REQUIRED): <br /> PRIMARY CONTACT: ❑OWNER �CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: �� . ������� <br /> �' � `� � <br /> � CONTACT EMAIL: � � � � � �� <br /> AGREEMENT:1 hereby certify that I ha e read and examined this application and know fhe same to be true and correcE Atl provisions o laws and ordinances goveming 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 regulafing construction or the performance of construction. That I am authorized by the owner of this property to perform Ehe 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 /> a PERMIT# <br /> ?�1 �,D 1� E ��I _ �..� <br /> Owner/Authorize Agent nature Date (Revised 9/23/2016) <br />