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�8/iz/z0i6 FRI 9: a3 FAx a25 25z i666 CM Heating �003/031 <br /> �ECTRICAL PERMIT A LICATION <br /> CITY OF EVERETT P�RMIT SERVICES <br /> 3200 CEDAR STREET, �V�RETT, WA 98201 <br /> {p)425-257-8810 � FAX 425-257-8B57 � (E)everatteps�everettwa.gov � www.everattwe.gavlpermits <br /> ���, `�' +Y�' :`.;' ,��;:, r�<�`�;, � ;.P�ROJEdT;�$ '�'�`��1�F?t'�RtVIA��Ib�N,. , . <br /> �- , , <br /> PROJ�C7 ADDRE88: � G <br /> BUILDING AR�A(If raeldentlel, new construcllon, remodgl,or addltlon) gF <br /> �UILDING TYPE: ❑ SFR-D�TACHED ❑ SFR-A7TACHED ❑ DUPLEX MULTI-FAMILY-(�OF UN17S�0�" ❑ COMMERCIAL <br /> U8E OF BUILDING: <br /> • - � � CTRICAL AP�'�,�CAT.ION;INFORMA'�"ION <br /> CONTRACT PRIC�pF WORK: " �. Q <br /> NUMBER OF DEVICES If low Ita e : ; <br /> FIRE ALARM? ❑YES �. ❑ NO <br /> AS80CIATED BUILDING PERMI f a Ilceble : � <br /> D�8CRIpTION �F WORK: (,` � � " <br /> � ,� <br /> � � � . , , , <br /> � � ' � ' � " CONTACT�1NFp1�1VIpT1(yN � <br /> OWNER NAM�: �' TENANT NA�I� If Commerclal : 1.�,�C � <br /> OWNER MAILING ADDRES3; 9TkEer (�O � <br /> aTr srATE l p� <br /> 21p <br /> OWNER PHONE; � � J� OWNER EMAIL: <br /> ' CONTI�ACTOR NAME: <br /> CONTRACTOR ADDR�3S: aTaE� "1( <br /> c i1v sr^Te zia <br /> COtJTRACTOR PHONE: �� CONTRACTOR EMAIL; ��y--�� <br /> CONTRACTOR 1.IC,#R�QUIRED): � ' C[TY OF EVERETT 6t19�INE33 LIC.#REqUIR D ; I D��' <br /> PRIMARY CQNTACT: ❑ OWNER ONTRAC70R ❑OTWER (Plaase Speclfy) -f - <br /> CONTACT NAME:'C��� �� CONTACT PHON�: a (} ' <br /> CONTACT EMAIL:(�'`,Q� � [j���� � <br /> AOREEMENT:T heroby oerttly tnat r hava read end ex�mined thla appllcatlon and know tne aeme ta be frue and oorreoL Al1 prov/sions otlaws d ord/nenose governing firls <br /> ryp�ol wwlc wlll be�omA/eted whether sp�o!llad hereln or nol, The qrantJng of a permlf doas not presuma to glva aufhorlty lo vro�afa or oanosl tfre provls/ons vf eny other staf�a• <br /> focal!aw iegulaf�np vonsiructlon or fifs performanca o(aonslrue!lon. Thef/am aufhorized by!he owRer o(thla property fo perlorm!h�work for whlch appl/cellon!s mude arrd I <br /> comply w!(h the Slsfe ConfractOra Law 18.27 RCW and 298.200 WAC. <br /> c�ry or�veretr o�;c�ei u8a onry <br /> FEE <br /> ti <br /> /�� PEI�MIT# I <br /> ; E ���� ���-�''�u <br /> Ownar/Authorlxed Apent 8lenature D ta (Revlsed 9QI92/2096) <br />