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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 I FAX 425-257-8857 I (E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> PROJECT SITE INFORMATION <br /> PROJECT ADDRESS: 671, 1 Y n C_)(SGA N) RD C (\ <br /> BUILDING AREA(if residential,new construction,remodel, or addition) SF -300 5 <br /> BUILDING TYPE: I 'SFR-DETACHED 0 SFR-ATTACHED 0 DUPLEX 0 MULTI-FAMILY-#OF UNITS: D COMMERCIAL <br /> USE OF BUILDING: ( <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK:$ 400_OD <br /> NUMBER OF DEVICES(if low voltage): <br /> FIRE ALARM? 0 YES JAO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIPTION OF WORK: RE(2(:14.CG OLo G( /2 c_rR C <br /> ZOO /)\nil <br /> CONTACT INFORMATION <br /> OWNER NAME: 'C`1GN) CA t(1-�.,5 (•\j TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET C(( B 1 \r'CZ V-4) <br /> ern( STATE Q C i T STATE V\-"\ ZIP C62_02 <br /> OWNER PHONE: Off- kO- r 3`7 Z OWNER EMAIL: <br /> CONTRACTOR NAME: C�x.i N (L <br /> CONTRACTOR ADDRESS: STREET <br /> CITY STATE ZIP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> CONTRACTOR LIC.#(REQUIRED): CITY OF EVERETT BUSINESS LIC.#(REQUIRED): <br /> PRIMARY CONTACT: D OWNER 0 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: <br /> CONTACT EMAIL: <br /> AGREEMENT.-T hereby certify that!have read and examined this application and know the same to be true and correct. All provisions of laws and ordinances governing this <br /> type 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 performance of construction. That!am authorized by the owner of this property to perform the work for which application is made and I <br /> comply with the State Contractors Law 98.27 RCW and 296.200 WAC. <br /> City of Everett Official Use Only <br /> FEE <br /> PERMIT# <br /> C' SEP 1.5- 2.0/7 E �} <br /> Owner/Authorized Agent Signature Date ) (Revised 10/12/2015) <br />