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/''� ELECTRICAL PERMIT APPLICATION <br /> , - _ CITY 0, =VER=TT PERMIT SERVICES <br /> ( } ZS-2 _ 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-3310 FAX 42:3-257-83.77 I (_) rwer.ttaps@everettwa.gov i www.everettwa.;:.Qvipecrrt{t.:, <br /> PROJECT SITE INFORMATION <br /> PROJECT ADDRESS. r <br /> 1111411 <br /> trtY sA <br /> 3,JrLDiNG AREA"r <br /> j.,-)-.T , <br /> iEE OF 3Ur,.. _ <br /> ELECTRICAL MIPL1CdT1ON. 1Nt-ORMAt ON <br /> CONTRACT PRICE Or WORK: $ <br /> NUMBER OF DEVICES (if low volta;ga): <br /> FIRE ALARM? ❑YES ❑ NO �� <br /> ASSOCIATED BUILDING PERMIT#t'f applicable) <br /> C144:L JC <br /> CaJ1 2-- <br /> ;;;NERNAME: j <br /> ini <br /> T`YAVT NAiG1E{If Cc,mmarWiatti: <br /> DNfYER MAILIY,a ADDRESS: <br /> t <br /> °/'....�r► ab. <br /> DoT aD .__ <br /> i 7 U. ,. r �c_ <br /> 1DUT,R Z:TDR ADDRESS: <br /> n, •• <br /> Ci <br /> .IP qY3 20 1 <br /> CONTRACTOR PHONE: * .4.—Ci «� <br /> 6 coni- croR EMAIL: ! ".,..0 <br /> .J/ i. <br /> � . . :r ry_ ::QNTRACTOR � . RED):C litc-�"I * ct?1_ —CITY <br /> OF EVERETT BUSINESS LIC..#{REOU1REDl: 0 0 -- lb__�._.__. <br /> PRIMARY CONTACT: 0 OWNER 'A CONTRACTOR <br /> 0 OTHER(Please Specify) <br /> CONTACT NAME: <br /> CONTACT PHONE: 5,, a5q <br /> I .n <br /> �✓� �C. CONTACT EMAIL:.dtici101 ,, 0 , it <br /> AGREEMENT:I hereby certify that f have read and examined this application and know the same to be(rue and correct. All provisions of laws and o In ea <br /> of work will be completed whether specified herein or not. The granting of a permit does not presume to glue euthorny to violate or cancel the provisions of any other slate cr <br /> local law regulating construction or the performance of construction. governing this type <br /> comply with the State Contractors Law 1x.27 RCW and 296.2GG WAC,That I am authorized by the owner of this roe to perform the work for which application is made and I <br /> property dY <br /> City of Everett Gffciat Use Cnly <br /> 'et <br /> t„ � PERMIT# <br /> vvr,arr ae£t erizsc Ageri Signature C � 0.— -g <br /> g <br /> Cate <br /> Orivlsed 9/231X16.1 <br />