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ELECTRICAL. P'ERMIT APuLIC,ATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVEREI-f, WA 9820'1 <br /> (P}425-257-8810 � FAX 425 257-8857 � (E)everetteps@everefitwa.gov� www.everettwa.gov/permits <br /> . . . ._ < , _� _. , _ . <br /> `' PROJECT SITE INFORMATION; ` <br /> PROJECT ADDRESS: � � ` <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 /> ;; .., . . .. <br /> ':. , ;; ELECTRIGAL APPLIC.ATION INFORMATION � <br /> CONTRACT PRICE OF WORK:$ <br /> NUMBER OF DEVICES(if low voltage):• � <br /> FIRE ALARM? ❑YES ❑NO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIPTION OF WORK: f ` � <br /> ` CONTACT INFORMATION. <br /> OWNER NAME: TENANT NAME(If Commercial): i <br /> OWNER MAILING ADDRESS: srReer <br /> CITY STATE ZIP � . <br /> OWNER PHONE: -� OWNER EM <br /> � <br /> CONTRACTOR NAME: <br /> CONTRACTOR ADDRESS: s-rRe�r � ;,,) <br /> e <br /> CITY STATE ZIP <br /> CONTRACTOR PHONE: �— CONTRACTOR EMAIL: � � <br /> CONTRACTOR LIC.#(REQUIRED): '"— �' C17Y OF EVER BUSI LIC.# EQUt E ): � � <br /> PRIMARY CONTACT: ❑OWNER CONTRACTOR ❑OTHER(Pfease Specify) <br /> CONTACT NAME: CONTACT PHONE: � <br /> = h� �)� CONTACT EMAIL: <br /> AGREEMENT.�T hereby certify that/have read and-examined this app/ication and know the same to be true a orrect. A! o �ions of/aws and o ances goveming this ` <br /> type of work wilf be completed whether specifred herein or not. The granting of a permit does not presume to give authority to vio/ate or cance/the provisions of any other state or <br /> /oca!law regulating consfruction or the performance of consfruction. That I am authorized by the owner of this property to perform fhe work for which appJication is made and 1 <br /> comply with the State Contractors Law 18.27 RCW and 296.200 WAC. <br /> Cify of Everett Official Use Onfy <br /> FEE <br /> ��� •� � <br /> PERMIT# <br /> �� � � �� E ���� � �� <br /> OwnedAut ized Age ign re Date (Revised 90/92/2095) <br />