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Jul 22 2016 02:54PM Exact �ectric Llc (206) 783-1413 page 1 <br />• <br />�ECTRICAL P <br />ERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />32a0 CEDAR S7REET, EVERETT, WA 98201 <br />(P) 425-257-8810 � FAX 425-257-8857 �(E) everetteps@everettwa.gov � www,everettwa.gov/permits <br />' � PRL1.�E�T StTE 11 <br />PROJECT ApDRESS: j � �� � <br />BUILDING AREA (if residential, new construction, remodel, or addltion) <br />BUILDING TYPE: ❑ SFR-DETACHED ❑ SFR-ATTACHED DUPLEX <br />SE OF BUILDING: <br />=ORMAT�D.N ,;.. <br />,. : <br />E ►,��- �I� g g zeti <br />SF <br />❑ MULTI-FAMILY - # OF UNITS: ❑ COMMERCIAL <br />COMTACT INF,ORMATl.�N ;, . <br />. _, - . <br />OWNER NAME: �� TENANT NAME (If Commercfal): <br />OWNERMAILINGADDRESS: sTREET )(°��//tiy �Ar„X_� � f�J / , ^L � r' _ I i �I , it �w � <br />OWNERPHONE: �L(��,- <br />cirv <br />�r7�1��� <br />NTRACTOf2 NAME: �nACI C <br />PlTRACTORADDRESS: srReer <br />aWNER EMAIL: <br />STATE Z�P <br />� OMni�.!'nn� <br />c irr <br />S-ATE ZIP <br />CONTRACTOR PHONE: y� CONTRACTOR E AIL i n a � � <br />CONTRACTOR LIC. #(REQUIRED): C E, '2,% R CITY OF EVERETT BUSINESS LIC. #(RE . Z,0 <br />_,. <br />PRIMARY CONTACT: ❑ OWNER CONTRACTOR ❑ �THER (Please Specify) <br />CONTACT NAME: CONTAC7 PHONE: 2 O6 - R J Q <br />�hwd � - 5 �yY -ti � - Gq� <br />v g � CONTACT EMAIL: GhQ e�q e.� � I g e,�-�.�'L ,�d <br />AGREEMENT.• T hereby certify that 1 have read and exeminad this applicaflon and know Ehe same !o be true and Comeck A!l provisions of /aws and orqinances govem(ng fhis <br />type o/ work wi!! 6e complefed whether speclfied he�ein or not. The grenting ol a permit does not presume to give authorityto violate or cancel the prow'sions of any otherstete o� <br />loca! !aw regulafing construction or the perfomranee oi constrvction. That ! am aufhvrized by ths owner of this property fo perform the work for which application is made and 1 <br />comply wiih the Sfate Conbactors Law 18.27 RCW and 296.200 WAC, <br />Signatura <br />Date <br />City of Everett Offlcia! Use Only <br />FEE <br />��� � � <br />PERMIT # <br />E ��o� -�S� <br />(Revised f0/12/2015) <br />