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Jul 29 2016 12:59PM Jim & Pat Bryatii 703 893-9812 page 2 <br /> I <br /> r <br /> ELECTRICAL PERMIT APPLIGATION ����C- � <br /> CITY OF EVERETT PERMIT SERVICES ��� i�`"f�� <br /> 3200 CEDAR STREET, EVERETT,WA 982Q1 <br /> (P)425-257-881Q � FAX 425-257-6857 � (E) everetteps@everettwa.gov � www.everettwa.govlpermits� <br /> PROJECT SITE INFO�tMAT1�N <br /> r ;�_ <br /> . _ �,..._ . . _. _ ., .. . <br /> PRO ECT ADDRESS: � I Q ��,�� a- � r <br /> BUI iNG AREA(if residential,new cons#ruction, remo ,or acdition SF <br /> BUIL !NG TYPE: FR-DETACHED ❑SFFi-ATTACHED �DUPLEX ❑ MULTI-FAMILY-#OF UNITS: ❑ COMMERCIAL <br /> USE F BUII-QING: �"j f��{,4 '�( f� ! "�G�,I p' - <br /> ' ELECTRICAL:�APPLICATIDN`INFORMA'1''I�N ` ��.:' `5� `' ` � ' ` . <br /> '`�. <br /> CON RACI"PRICE�F W�RK:$ <br /> NUM ER OF DEVICES if low volta e : <br /> FIRE LARM? 0 YES O NO I <br /> � <br /> ASS CIATED BUILDtNG PER ap iicable : 1 <br /> DE5 RIPTION OF WO . � � S � � b b � .� <br /> 1 <br /> CONTACT INFQRMATlON . � ' ` ' � �'f� <br /> z �, <br /> OWN R NAME: �C.,T� TENANT NAME If CammerGat ; '� <br /> OWN R MAILING ADDRESS: srREer G�,' �;Q_ � i <br /> CfTV 37ATE ZIP �� V�1 <br /> �WNE PHONE: � OWNER EMAIL; -� O I i <br /> CONT CTOR NAME: I <br /> CONT ACTOR ADDRES5: srReer <br /> CITl� 3TATE ZtP <br /> CONT ACTOR PHONE: CONTRAC70R EMAIL: <br /> CONT ACTPR UC. *{REQUIRED); CITY OF EVERETT BU51NE5S LIC. k(REQUIRED}: <br /> . . _ _ ..__ _ . _ <br /> PRIMA Y CONTACT: OWNER O CQNTRACTOR ❑OTHER{Please Specifyl <br /> CUNT . CONTACT PHON�: �3.� � — � <br /> � CONTACT EMAIL: �'� f <br /> AGRE�' ENT:T hereby cartify that!have res and examined thrs applrceNon and know fhe ea to be true enaf corre . A!f qovislona oi laws a rciinences gvverning this <br /> type ot rk wili be completad whether specilred herein or not. The granting o!a permit does n f presurnp fo give sutharify to vrala[e or certca!tha provisior�s af any othsr atata or j <br /> loca!!aw regulating construetion a tne performance o/consfruclion, 7iret/am authonzer!6y the owner of th/s property to perform fhe wnrk for which appGcaUon ie made and! i <br /> compfy (th the Stafs Contractors Law 78.27 fPCW and 296.20(1 l�VAC. <br /> Cily o/E+re�elf O/ficia!Use only <br /> FEE <br /> �r�'', . =--- =�- <br /> �J <br /> PERMIT# <br /> - �� �� � �u� '���� E ���`�-- � �� � �� <br /> � � <br /> ner/A horized Qqenf Signature Date (Revlsed f0/12/20i5J <br />