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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 /> PROJECT ADDRESS: �� ;� f�. �J/��L- /�{ <br /> BUILDING AREA(if residential, new construction, remodel, or addition) zc�c.�C� SF <br /> BUILDING TYPE: ❑ SFR-DETACHED FR-ATTACHED ❑ DUPLEX ❑ MULTI-FAMILY-#OF UNITS: ❑ COMMERCIAL <br /> USE OF BUILDING: �. "`- � - <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK: $ SOC�Z� `� <br /> NUMBER OF DEVICES (if low voltage): <br /> FIRE ALARM? ❑YES ❑ NO <br /> ASSOCIATED BUILDING PERMIT# (if applicable): <br /> DESCRIPTION OF WORK: �✓/�'� i✓/�!{'�'"�vs��� �.5�'��+��� <br /> v' LY-�2-ffp�' 1�i�p� i.✓'�� W`� �,-i,,r,. <br /> Zt/�j c'i•7.�y ��3�;�j�,�� <br /> CONTACT INFORMATION <br /> OWNER NAME: c./� �/� �� � TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: sTREEr � <br /> C IN STATE ZIP <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: ����.�G''��� ��-���/�/C;- ��� <br /> CONTRACTOR ADDRESS: � � � G'� � � / <br /> �I����r�/� STATE L���/ ZIP ���� <br /> CONTRACTOR PHONE: �J �/����I C� CONTRACTOR EMAIL: �U��L���/ �19L°��?� � � . �?(J <br /> CONTRACTOR LIC.#(REQUIRED): �j�� �� /� CITY OF EVERETT BUSINESS LIC.#(REQUIRED): C:,`���U��GJ '�J <br /> PRIMARY CONTACT: WNER 1�6ONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: `f Z;S � �� ������ <br /> ��i.�//�, l7l�(.��� CONTACT EMAIL: <br /> AGREEMENT:1 hereby certify that I have read and examined this application and know the same to be true and correct. All provisions of laws 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 pertormance of construction. That 1 am authorized by the owner of this property to perform the work for which application is made and 1 <br /> comply with the State Contractors Law 18.27 RCW and 296.200 W,4C. <br /> City of Eve�ett Official Use Only <br /> , . <br /> PERMIT# <br /> � E �'!�-�`�`-; <br /> Owner/Authorized Agent Signature Da e (Revised 9/23/2016) <br />