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0 0 <br /> ELECTRICAL PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 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 /> PROJECTADDRESS:-�[� L V\ , <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 /> CONTRACT PRICE OF WORK:$ a,CZJ: 'c <br /> NUMBER OF DEVICES (if low voltage): <br /> FIRE ALARM? ❑YES P NO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIPTION OF WORK: <br /> - ('t) <br /> i C <br /> CONTACT INFORMATION / yy�� // <br /> OWNER NAME:"f ) 7 TENANT NAME(If Commercial): {P- C2rr /14c o rrr,ol-- <br /> OWNER MAILING ADDRESS: STREET)O,) / tJ A #x-12-12- <br /> CITY <br /> 2.lZCITY STATE <br /> OWNER PHONE: OWrNER EMAIL: <br /> CONTRACTOR NAME: <br /> CONTRACTOR ADDRESS,�O in STREET `_.t� PZ <br /> CITY E�f :`•'(1 ' ( ;` STATE Z'P <br /> CONTRACTOR PHONE:5kD' .7!- / j Lt CONTRACTOR EMAIL: 4) a) <br /> CONTRACTOR LIC.#(REQUIRED): 51 iJQ J (p P CITY OF EVERETT BUSINESS LIC.#(REQUIRED): Q5r7�o <br /> PRIMARY CONTACT: ❑OWNER ACONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: 3�j (f7 j <br /> LxDlr 1 e- CONTACT EMAIL:Lit i -Si, J . a- j.SY} <br /> AGREEMENT.T hereby certify that I have read and examined this application and know the same to be true and correct. All provisions o 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/ <br /> comply with the State Contractors Law 18.27 RCW and 296.200 WAC. <br /> City of Everett Official Use Only <br /> FEE <br /> 4( <br /> PEER IT# <br /> Ownerl horized Agent Signature Date (Revised 10/12/2015) <br />