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0 <br /> *LECTRICAL PERMIT APPLICATION <br /> OLCITY 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 1 www.everettwa.gov/permits <br /> PROJECT SITE INFORMATION <br /> PROJECT ADDRESS: } ti j �W -?--(I —A--_ •----- <br /> BUILDING AREA(if residential, new construction, remodel,or addition) I C SF <br /> BUILDING TYPE: ❑ SFR-DETACHED ❑ SFR-ATTACHED ❑ DUPLEX tg.MULTI-FAMILY-#OF UNITS: ❑ COMMERCIAL <br /> USE OF BUILDING: <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK: $ <br /> NUMBER OF DEVICES (if low voltage): <br /> FIRE ALARM? `T l YES ❑NO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): ;�! {A,• <br /> DESCRIPTION OF WORK: (. <br /> S—) - tum 1 ck t v> <br /> CONTACT INFORMATION <br /> OWNER NAME: `�j i<\� b� -=rte -, TENANT NAME(If Commercial): S�yyv1 <br /> OWNER MAILING ADDRESS: STREET '7Z[ cc)J }, � <br /> CITY Lv \ �— STATE W z�r 2O- <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: L`) i <br /> CONTRACTOR ADDRESS: STREET 7. LULL, 4� <br /> alk-cc- <br /> CONTRACTOR <br /> CITY (, '., STATE - ZIP <br /> CONTRACTOR PHONE: Z�• ,• Cil CONTRACTOR EMAIL: <br /> CONTRACTOR LIC.#(REQUIRED): CT,} - ���� CITY OF EVERETT BUSINESS LIC.#REQUIRED : <br /> PRIMARY CONTACT: ❑ OWNER b CONTRACTOR ❑ OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: 1 � Cl � <br /> CONTACT EMAIL: �� 4 _l1L) <br /> AGREEMENT Thereby certify that l 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/ <br /> comply with the State Contractors Law 18 27 RCW and 296.200 WAC. <br /> City of Everett Official Use Only <br /> FEE <br /> n PERMIT# <br /> Owner/Authorized Agent Signature Date <br /> (Revised 10/12/2015) <br />