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0 <br /> Or-ZLECTRICAL PERMIT Af�PLICATI®fV <br /> CITY OF EVERETT PERMIT SERVICES <br /> OL 3200 CEDAR STREET, EVERETT, WA 98201 <br /> (P) 425-257-8810 FAX 425-257-8857 1 (E) everetteps@everettwa.gov I www.everettwa.gov/permits <br /> PROJECT SITE INFORMATION <br /> PROJECT ADDRESS: , (� <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 /> USE OF BUILDING: <br /> ELECTRICAL APPLICATION INFORMATION <br /> j• CONTRACT PRICE OF WORK: $ -112. <br /> NUMBER OF DEVICES(if low voltage): <br /> FIRE ALARM? YES ❑ NO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): ,A 4N- <br /> DESCRIPTION OF WORK: t` C NAk <br /> CONTACT INFORMATION <br /> OWNER NAME: `�I �� LL � TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET <br /> C CITV Lv C�L-�� STATE � ZIP G 'K/� <br /> OWNER PHONE:�2�j - OWNER EMAIL: <br /> CONTRACTOR NAME: t ) F <br /> CONTRACTOR ADDRESS: STREET .," <br /> STATE ZIP C <br /> CONTRACTOR PHONE: —[CONTRACTOR EMAIL: �� ( 6L , <br /> CONTRACTOR LIC.#(REQUIRED): V."\t./ CITY OF EVERETT BUSINESS LIC.#(REQUIRED): <br /> PRIMARY CONTACT: ❑OWNER b CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: <br /> Lc)�0 <br /> ` 1 t U�(�-✓ CONTACT EMAIL: r l <br /> AGREEMENT: Thereby 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 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 I 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 WAC. <br /> City of Everelt Official Use Only <br /> FEE <br /> PERMIT# l� <br /> OWnerlA orized Agent Signature Date <br /> (Revised 10112/2015) <br />