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83/17;'2016 12:03 4254267�5 HERSETH � P�GE 02 <br />ELECTRiCAL PERMIT APPLICATiON <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STR�ET, EVERETT, WA 982�1 <br />(P) 425-257-8810 � FAX 425-257-8857 �{E) everetteps(�everettwa.gov � www.everettwa.gov/permits <br />� CONTACT INRORMATION 1 <br />ER NAME:��^C�`�' C�f��--q-�� �\��.U, a, � �"�E�NT NAME <br />OWNER MAII.ING ADDRE33: srr?eeT \.I� �`I <br />CITY � �C � � � C\ STATE ... � `� yip � l �p O <br />OWNER PHONE: CX�'— � 0� OWNER EMAIL: � p�� � <br />CONTRACTOR NAME: v.�.� ��- � C'�^�� C. C�,� �j-�,�� ��� <br />CONTRACTOR ADDRE8S: sra�Er Q�� ``{ a'y"h S�— . S���ri Z <br />c�n �ii �� C� C. � X stnT6 La..) I�1 z1P � <br />CONTRACTpR PHONE� �-}��a -„� Z2 �`'� 3. CONTRAC70R EMAIL: � C.(�q \` �_ �,��;�,�-' C <br />CON7RACTOR LIC. # RE�UIRE� : � `"1`-1 �C.Q GITY OF EVERETT 6U$IN�$$ LIC, iY R�QUIR�p): ���`-' ��' ° ��1 <br />PRIMARY CONTACT: O OWNER `�ONTRACTOR 0 OTHER (Please Specify) O�� a� <br />CONTACT NAME: CONTACT PHONE: y'�,�j _ 3 z2 � C7 3 Co �--� <br />�c.-, o. ��.rr c�NTacT �Ma��: a�o,c�C G.,�-, �- — N��,c���-;�'.�.� - ��.r.,;� , <br />AGR MEN7: 1 here6y certrrylnet 1 neve r�eed enC �xamineC thls applfcetlon and k»ow (hn sarna b be truo mnd corrmct, A!! provisrons o/aws and ordfiences govem/ny thla ry�eGQ� <br />pf w k wfd be complefed whelher apacifed here/rt or not. 'ihe grenfing of e permit doBs not presurpe f0 glvg aU1n0�ry t0 v101afe o� r.ance! the provislons of eny other sfete or <br />loca! law repuJntinp construcfion or the poAormanco of construction. Thal I am euthorized by the owner of this properfy to parform f�e work Io� wh(ch dnp7ication is mede end ! <br />�COMpI!� W1fh (�7�! SIB�� CPf72Y&Cf0/S �3iW 1B.,27 i�CW Cl/d 29B.z00 WRC. <br />m <br />� <br />horized AOent�Sipn�tun � � Dato <br />Clry o1 �veret! d/ryclal Use Only <br />PERMIT # <br />E � �( <br />(Reviaed 8/23/201B) <br />