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� <br /> g �EC7'I�ICAL �'IERMI�' A��,I�l�►�'I+��V <br /> ; <br /> � <br /> � CITY OF EV�f�E"fT f�Ef�MI-f ��f:IZVI(:i_::; <br /> � 32.00 C�DAR STREET, CVCRETT, W1� saf31O1 <br /> E <br /> � {P) 425-257-�$10 � FRX 425-257-�857 � (E) everetteps(wc;veretiwa.yc,v � www,�;verr;�lw��,��uv/�,,;�iiiil,� <br /> � � <br /> i <br /> PROJEC7 51TE INFO�tMA`T'll'�1�1 �._��" <br /> i <br /> PROJECT ADDRESS; 3 "'"'""' <br /> _....__ __.__...____------�____._ - ._ <br /> k BUILDING AREA{if residential, new construction, remodel, or aJdilion) g� <br /> `r <br /> - -- <br /> � BUILDING TYPE: SFR-DETACHED ❑ SFR-l+TTACHED ❑ DUPLEX ❑ MUL��I-f=AMILY-il U( UI li I S:_ f I C:��MMI I;t,inl <br /> �__._�__.__ .�.. __._._ -- <br /> � USE OF BUILD�NG: <br /> G <br /> i � <br /> � ELECTRICAL APpLICATION INFORMATION �� <br /> CONTRACT PRICE OF WORK: $ � ,a' <br /> G <br /> � NUMBER OF DEVICES (if low volta e : ` �� <br /> ; FIRE ALARM7 ❑ YES ❑ NO ��� <br /> t <br /> a <br /> ��' AS50CIATED BUILDING PERMIT#(if ap licable : � � � <br /> DESCRIPTION OF WORK: I �'�} � —" ----- <br /> �: ��' — — _T__ <br /> � �...� _,_�___ _ <br /> w <br /> E <br /> � _'_' __' — _ _ <br /> i. <br /> - ______..._.. <br /> _w.__,_..___.._._..... . <br /> � <br /> � CONTACT INFORMATION <br /> OWNER NAME: I'�, (, fil�O L <br /> TENANT NAME(If Commc�rcla� : <br /> OWNER MAILING ADDRESS: srReer ---------- -- <br /> crrv ��ilr i , h � ---�-... �0..� <br /> � .^,�rni[ �J CI�� .- <br /> OWNER PHONE: OWNER EMAIL �� �"`�""" <br /> CONTRACTOR NAME: '� -"____ -- - <br /> CONTRACTOR ADDRESS: srReer I L-{(� �'O� — �__.___ _ <br /> c irv ( —,___....�_.__ <br /> _�___.__ <br /> � � �G ..,��� � c�`C� 2c� � <br /> CONTRACTOR PHONE: 1�, =��• <br /> CONTRACTOR EMAIL: d� r��P �' �4 y��`-,"—��z'� __ <br /> CONTRACTOR UC.#(REQUIRED):CYhhe �� '�d� �_LL��_ 1lQ Vy J <br /> � CITY OF EVERETT BUSINESS LIC.J�(It1�caU�1:1=U ; t� <br /> PRIMARY CONTACT: ❑ OWNER CONTRACTOR ❑OTHER(Please Specify)` �����'--��� <br /> CONTACT NAME: �------------------______ <br /> CONTACT PHONE: �.. <br /> as ��q � � � ___._-_ __ <br /> � �E%�LxL��. CONTACT EMAIL: ' ' _.—...—.._.____.___.._.,.______ <br /> AGREEMElJT.�I hereby cerlify fhat!have read and examrned(his app/icafion and know the same���f�U�orr�l. /U! ���j�� ' C�� <br /> ol work will be completed whelher specrfied herein or not. T1�e gran(ing ol a permit does no(presume�o glv�outhoiit� <br /> Ioca/1aw regulating construction or the perlormance of consliuction. That!am au(hoilzed by(he ow�tr;r ol llds prope�ly to petJont�ry����i,���j���N�� f'`II 1,1„���,������'Nr�ui���i�ii't��n� <br /> comply wi(h(he S�ate Contraclors Law i8.27 RCW and 296.200 WAC. } lo vlolafe or canci�l the�nuvisiuns i,l eiri��r�fh�u,I,�t�;,u <br /> 1/ h�i�lun l,ti�in:ulu nirtl 1 <br /> r' <br /> (;lfy nl l�Vu���fl l�lllr.lnl llr,u i�nh <br /> ��� �� r��.r�Mi�� �i <br /> �----� cu,t..�., 4 •2.2 • j� <br /> OwnerlAuthorizad Ayont S g ature � ��� .� '�� <br /> .._ D�le _'"_' <br /> , (l�vvi�e��l!)/2:i%7i�ftt) <br />