Laserfiche WebLink
0 <br /> * 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.everetNva.gov/permits <br /> PROJECT SITE INFORMATION <br /> PROJECT ADDRESS: 27kl L �CJl <br /> BUILDING AREA(if residential, new construction, remodel, or addition) SF <br /> BUILDING TYPE: ❑ SFR-DETACHED ❑SFR-ATTACHED ❑ DUPLEX T21,MULTI-FAMfLY-#OF UNITS: nCOMMERCIAL <br /> USE OF BUILDING: <br /> ELECTRICAL APPLICATION INFORMATION <br /> ff <br /> RICE OF WORK: $ j DEVICES (if low voltage): <br /> FIRE ALARM? .p YES ❑NO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): t-1 v',- <br /> DESCRIPTION OF WORK: �,�,�� <br /> V <br /> CONTACT INFORMATION <br /> OWNER NAME: TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET iZCj � V-6 <br /> CITY-E 'er STATE -- 12 <br /> �Ze`7 • Z�it� • ` ZIP <br /> OWNER PHONE: <br /> OWNER EMAIL: <br /> CONTRACTOR NAME: ��� <br /> CONTRACTOR ADDRESS: STREET7,1 �� -A <br /> U <br /> + 'fC>vC� sTATE Z1F <br /> CONTRACTOR PHONE:L=` CONTRACTOR EMAIL: e <br /> CONTRACTOR LIC.#(REQUIRED): `t i CITY OF EVERETT BUSINESS LIC.#(REQUIRED): <br /> PRIMARY CONTACT: ❑ OWNER b CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: <br /> CONTACT EMAIL: ��. t dal /�—� <br /> AGREEMENT.Thereby 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! <br /> comply with the State Contractors Law 18.27 RCW and 296.200 WAC. <br /> City of Everett Official Use Only <br /> FEE <br /> I PERMIT# <br /> Owner thorized Agent Signature bate <br /> (Revised 70/12/2015) <br />