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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 1 FAX 425-257-8857 1 (E) everetteps@everettwa.gov I www.everettwa.gov/permits <br /> PROJECT SITE INFORMATION <br /> PROJECT ADDRESS: 19,W Me,+rlr 1 I I Nce­v, r� PX e- 4- U, -A L @�() <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 /> I, <br /> USE OF BUILDING: <br /> ELECTRICAL APPLICATIONINFORMATION E <br /> CONTRACT PRICE OF WORK: $ , <br /> NUMBER OF DEVICES (if low voltage): <br /> FIRE ALARM? ❑YES ANO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIPTION OF WORK: 'ey <br /> ria rb bor. <br /> CONTACT INFORMATION <br /> OWNER NAME: A TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET n,� Q�r i �✓1eQ V <br /> CITY STATE LIP O <br /> OWNER PHONE: 5 L40q- OWNER EMAIL: <br /> CONTRACTOR NAME: <br /> CONTRACTOR ADDRESS: STREET V- <br /> CITY STATE I <br /> _ ) ZIP 8 i <br /> CONTRACTOR PHONE: D - CONTRACTOR EMAIL: r IGS(= �C� nou. w k <br /> CONTRACTOR LIC.#(REQUIRED): I CITY OF EVERETT BUSINESS LIC.#(REQUIRED): Ot-� <br /> PRIMARY CONTACT: ❑OWNER ❑CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT TAME: CONTACT PHONE: Cqa,) b I CJ <br /> LjG�p� k Cj,(` CONTACT EMAIL: <br /> rQ. ► Q Com. � - Lo <br /> AGREEMENT.,T 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 <br /> type of work wi,'I 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/ <br /> comply with the State Contractors Law 18.27 RCW and 296.200 WAC. <br /> City of Everett Official Use Only <br /> FEE <br /> 1 <br /> I <br /> PERMIT# t <br /> CI <br /> Owner/Authorized 44t Signature Date (Revised 10/12/2015) <br /> 4 <br />