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f <br /> # <br /> ELECTRIC�4L 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 /> t <br /> PROJECT SITE INFORMA7'ION � <br /> PROJECT ADDRESS: � � ?"�''�� '? ;.� 1� � <br /> BUILDING AREA(if residential, new construction, remodel,or addition) _` T � 5F <br /> BUILDING TYPE: SFR-DETACHED ❑ SFR-ATTACHED ❑ DUPLEX ❑ MULTI-FAMILY-#OF UNITS: G� COMMERCIAL <br /> USE OF BUILDING: -- ,--�t;t t�,- , r�� - ' <br /> ICAL APPLICATION 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: !\,L�t,,;' s � .-,; { ,� ;� ;; _ <br /> � <br /> CONTACT INFORMATION <br /> OWNER NAME: ��,jt�r^ �iig;,t��i� TENANT NAME(if Commercial): <br /> OWNER MAILING ADDRESS: srReer aLLS"� { .>� �;•��,,, , �,� <br /> ciTv �'" '�,r -���� srnTe `�.. :' zir i `� �.� <br /> OWNER PHONE: —,"}'�'- ` ? �? ? OWNER EMAIL: <br /> ;: <br /> CONTRACTOR NAME -� -,''� '�� �: `: <br /> _ [ <br /> CONTRACTOR ADDRESS: sTReer ,'' `+ ' <br /> , �: <br /> CITY ,✓ A-t�. k STATE � � ZIP '�'" � : p <br /> I'� <br /> CONTRACTOR PHONE. ' ' . ' - '�:�� CONTRACTOR EMAIL ',- ' � < ' ' '. <br /> CONTRACTOR LIC.#(ReQUIRED): ,-�: ` : � � (l CITY OF EVERETT BUSINESS LIC.`#(REqUIR ) !`��v� � <br /> � <br /> PRIMARY CONTACT: ❑OWNER L�`CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: -. -- <br /> v~ � � � CONTACT EMAIL. :; f, ,,;. <br /> . `; <br /> AGREEMENT:1 hereby certity that!have read and examined this application and know the same to be Uue and correct. All provisions of IaU�s and ordinances goveming this type <br /> of work wi!/be complefed whether specified he�ein or not. The granting ol a permit does not piesume fo c�ive authority to violate or cancel the provisions of any other state or <br /> locallaw regulating construction or the performance of construction. That!am aufhorized by the owner o!this property to perlorm the work lor which application is made and 1 <br /> comply with the State Contractors Law 18.27 RCW and 296.200 WAC. <br /> � <br /> �i <br /> City of Everett Official Use Only <br /> �: <br /> PERMIT# " <br /> r <br /> ,� f � E 1�-0� --61 C� : <br /> Own�r/Authorized Agent Signature Date (Revised 9/23/20i6) <br /> t <br /> i <br />