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ELECTRICAL PERMIT APPLICA7tON <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> (P)425-257-8810 � FAX 425-257-8857 � (E)everetteps@everetiwa.gov � www.everetkwa.gov/permits <br /> 1�!RC)J�GT a�i�'T�:11�Ft1R1V'IATtt�N <br /> PR�7JEGT�1�bRESS: p��� " <br /> BUILDING AREA(i(resldentlal,new construction,remodel,or addition} SF <br /> BUILDING TYPE: R-D�TACHED ❑ SFR-ATTACHED ❑ DUPLEX ❑MULTI-FAMILY-#OF UNITS: �COMMERCIAL <br /> USE OF BUILDING; <br /> ELEC'T'R�C��IIL.�APP�.���1'1'�ON�`lN��C1�M�tIC�N <br /> CONTRACT PRICE OF WORK: $ (� ,� <br /> NUMBER OF DEVICES(if low voifa e : <br /> FIRE ALARM? ❑YES ❑ NO <br /> ASSOCIATED BUILDING PERMIT# ifi a licable : <br /> DESCRIPTION OF WORK: • <br /> CCFN7'ACT II+1�C�Rl�;ATit�M <br /> O'WNER NAME; �, TENANT NAME !f Commerciaf : <br /> OWNER MAILING ADDRESS: srReer <br /> C(TY STATE �� � Z1P � � <br /> OWNER PHONE: OWNER EMAIL: <br /> CC�NTRAGTOR NAME: � <br /> CONTRAGTOR ADDRESS: sTReer ' � �QQ� <br /> C�TY � STATE 21P �� ��� <br /> CONTRACTOR PHONE: Cj CONTRACTOR EMAIL: , Yyf <br /> CONTRACTOR LIC.#(REqUtREp):��E �+}, "�d�l CITY OF EVERETT BUSINE5S LIC.#[FtEGtUIREf7): <br /> PRIMARY CONTACT: ❑OWNER CONTRACTOR ❑OTHER(Please 5pecify) <br /> CONTACT NAME: CONTACT PHONE: �� a�C� �� <br /> � ��,,,�Q,�Q�e CONTACT EMAIL: �� � ( K t'�G�1 C0�"! <br /> AGREEMENT:!hereby cerfi(y thaf t have read and exemined fhis appticafion and know Ihe same to be true and coriect. Al!provisions oflaws and oidinances goveming this(ype <br /> ol work will be comp/eled whelher speclfied hereln or not. The granting of a peimlt does not presume fo glve euthorfty to Nolale or cance!fhe provlslons ol any ofher state or <br /> locaf law regula(!ng consfrucfiott or fhe performance ol conslrucfion. That 1 em aufhorized by(he owner o1 fhfs property!o pe�form fhe work fo�whlch apptfcafion is made end I <br /> comply wllh lhe Sta/e Contracfors Law 78.27 RCW and 296.200 WAC. <br /> Clty of Everett Officla!Use Only <br /> PERMIT# <br /> � <br /> ���� �c�ue� � I o �t?•�_ E ? f -J -- �,:f <br /> OwneOAutFt� arl� x� ed Agent Slgnature Dale (Revised 9/23/2016) 1 <br />