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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 /> PROJ,ECT SITE:INFORMATION ' <br /> _ ,_ . ,�_ .�,� ,y� ., _. ,. <br /> . <br /> PROJECT ADDRESS: ID �S � �v,Q,('.e �J� � <br /> ✓ <br /> BUILDING AREA(if residential, new construction, remodel,or addition SF <br /> BUILDING TYPE: ❑SFR-DETACHED ❑SFR-ATTACHED ❑ UPLEX ❑ MULTI-FAMILY- F UNITS: '�COMMERCIAL <br /> USE OF BUILDING: ,�� q, !t G�i <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK:$ � <br /> NUMBER OF DEVICES (if low volta e): <br /> FIRE ALARM? ❑YES C�"NO <br /> ASSOCIATED BUILDING PERMIT#(if applicable : <br /> DESC�PTION OF W�RK: « � � , <br /> ( -^ �.�1 /� <br /> .- � <br /> ONTACT INFORMATION <br /> OWNER NAME: T NANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: srReeT �� 'L'� j t/I -lj' bSP�p.'("O � b����OCS�� <br /> � STATE � � ZIP � u � <br /> OWNER PHONE: L 2 '� — OWNER EMAIL: <br /> CONTRACTOR NAME: �' (r�ij <br /> CONTRACTOR ADDRESS: srReeT !fU W � G B/�t/J S <br /> I . (/EYATE,� ,. ZIP <br /> CONTRACTOR PHONE: L � '�(�I� CONTRACTOR E AIL: " �iU � ( (✓1 �� ,S � d� <br /> CONTRACTOR LIC.#(REQUIRED): � ITY OF EVERETT BUSINESS LIC.#(REG2UIRED): � <br /> PRIMARY CONTACT: ❑OWNER �CONTRACTOR �d OTHER(Please Specify) i! � <br /> CONTA T NAME: CONTACT PHONE: L�Z � ' � Ll G <br /> ��(�!� � CONTACT EMAIL: 1� ��u/J <br /> r <br /> AGREEMENT.�I hereby certify that I have read and examined this application and know the same to be true and correct. All provisions of la 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 1 am authorized by the owner of this property to pertorm 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 � ��� - Z�� <br /> O ner/Authorized Agent Signature Date (Revised 9/23/2016) <br />