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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 /> PROJECT SITE INFORMATION <br /> ° - , <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: �� � /vL,�,��� <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK: $ � �i�.%C.� • <br /> NUMBER OF DEVICES if low volta e : �j <br /> FIRE ALARM? ❑YES O <br /> ASSOCIATED BUILDING PERMIT#(if applicable = <br /> DE$CRIPTION OF WORK: t. � i ���,���-� ti� � <br /> l ����t�,����-v-1,-� � . <br /> CONTACT INFORMATION <br /> OWNER NAME: � {—t�,� �, TENANT NAME(If Commercial): — <br /> OWNER MAILING ADDRESS: sTaeEr rj�-�-- I�L� � �� �L= <br /> crrv .�.� �j � � � <br /> �`�� ' `/I , STATE G/ ZIP � <br /> OWNER PHONE: �� �-i �� 3 OWNER EMAIL: � L��� _ -' �,'��� C��; ���p�,. C' ZL <br /> CONTRACTOR NAME: ��� (C'-(-�/���_ �7 I <br /> CONTRACTOR ADDRESS: srn�Er <br /> C� STATE ZIP <br /> CONTRACTOR PHONE: 1-(�� , ,�j�• I • '�,�-� CONTRACTOR EMAIL• <br /> CONTRACTOR LIC.#(REQUIRED): CITY OF EVERETT BUSINESS LIC.#(REQUIRED): <br /> PRIMARY CONTACT: ❑OWNER OAITRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: <br /> CONTACT EMAIL: <br /> AGREEMENT:I hereby certify that I have read and examined this application and know the same to be true and correcf. AN provisions of laws and ordinances governing this type <br /> of work wi/l be completed whether specified herein or not. The granting of a permit does not presume to give authority to vio/ate or cancel the provisions of any other state or <br /> local law�egulating construction or the performance of construction. That I am authorized by the owner of this property to pertorm the work for which app/ication is made and I <br /> comply with the State Contraciors Law 18.27 RCW and 296.200 WAC. <br /> _ City of Everett Official Use Only <br /> ` PERMIT# <br /> �, « ��-� 2� , � - E � �l � �-b�� <br /> Owner/A d ent ignature Date (Revised 9/23/2016J <br /> � <br />