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Sep 27 17 10:32a Vickie 914838 p.1 <br /> �-=°t-�- �a �t��( 1 - ��3� �-�- L��� C�c�'� <br /> ELECTRICAL PERi1111T APPL�CATIOt� <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 982�1 <br /> (P)42�-257-8810 � �AX 425-257-8857 � (F) everetteps@everetfwa.go� � www.everettwa_gov/perr�its <br /> - PR�JECT SiTE INFORMATION <br /> P12OJECT ADDRESS: �� � t, �� <br /> BU1LDfNG AREA(if residential, newconstruction, rerrtadel, or addition) g� <br /> 8UILDING TYPE: ❑SFft-DETACHF_D ❑SFR-ATIACHED � DUPLEX ❑ MULTI-FAMILY-#(�F UNITS: ❑ COMMERCIAL <br /> USE OF OUILQING; � �� � � <br /> ELECTRiCAL APPLICATION �NF�RMAT[ON <br /> CONTRACT PRICE OF WORK: $ ('�, �"'� <br /> . � <br /> NEUMBER�F DEVIGFS (if low volfage): <br /> FIRE ALARIV�? ❑ YES �j�p <br /> ASSOClATED BUIL.DING PERMIT#(if applicable): <br /> DESCWP710N OF WORK: (��-�-y��,�., �Uz�� - <br /> C�NTQGT INFORMATiON <br /> OWNER NAME: ,� �('��-- TENANT NAME(if Commercial): <br /> OWNER N1t11L1NG Ai�DRESS: Srt�Esr 2 Z �� ,r�, �! �S �-r, <br /> �in (=c P�}-,— �e4-Y srATe c,c>/�-- ZP�r�! - 3 � <br /> OWNER PHQNE: OWNER EMAIL: <br /> . _ _.. ._ <br /> _._ _ , . . <br /> _ _ . <br /> _. . <br /> COTtTRACTOR lVAME; �, � Q —�i <br /> COEVTRAC7dF2 ADDRESS: srrteer S <br /> �� U I � C. STATE Zp �� <br /> COI�ETRAGTOR PliOPIE: O(O�I— �-J=�3� COIVTRACTOFZ EMAIL• V I.LJ ��� Ct. LU r/c� ,IjI[,L e, 1.;e1JL' <br /> CONTRACTOR LIC.#�R�QuiREn): �t�U�,����� CI'TY OF EVERETT BUSIfVESS Lf C.#(REC2UlRED): O 19 cSc�� <br /> _ : . .. _ .. <br /> . . . _.._.... <br /> _ ._ _._. .__ -- _-... _ . _.. . .... ... ... . . .. <br /> _ _. <br /> _._.. <br /> PRIMARY CONTACT: Q dWNER �NTRACTOR 1� OTHER(Please Specify) <br /> CONTAC�hlAME: CONTACT!'HONE: �L�) ��� _����/ <br /> I <br /> � jC�f�L--l-� l�e-� y�q�.� �i COIVTAC�EMAIL: \ � � I <br /> V �- I 'E-c.l I�'1 LF�"1�'� 4�LL�/� �C.C� ' ti�� <br /> AGREEMENT.-T hefeby cerfiFj thaf!have read and examined this a�pLcatron and know the same to be true and co�rect. All provisions oflaws and oirlinances go veming this <br /> fype of work wiI!be completed whether spec�ed herein or not. The granfing of a permit does not presume to give authonfy to violate or cance!the provisions of any oiher sta te or <br /> focsl 1aw regulating constiuction orfhe perfarmance of consfruction. That l am authonzed by the owne�oi this property to perform fhe xrork for which applicafion is made and I <br /> comply with fhe State Confractors Law 98.27 RCW and 296.200 WAC. <br /> City of Everott O�cia!Use Only <br /> FEE <br /> � '12, '�-� <br /> PCRMfT# <br /> � �-�.����-�-- �-� ��>> E I'�o� � 2��l <br /> Owner/Authorized qgent Signature Date (Revised 10/92/Z075) <br />