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10I30/2017 09 : 41 #2815 P. 002/004 <br /> � • <br /> El��CTRICAL P�RMIT APPLICATION <br /> C{TY OF EVER�Tf PERMIT S�RVIC�S <br /> 3200 CEDA12 STR�ET, �VERETT,WA 98201 <br /> (p)425-257-8810 ( FAX 425-257-8857 � (�j evere#eps�everetfwa.gov( www.everettwa.gov/permits <br /> . ,. <br /> . ,. . <br /> ,: <br /> , : ,: ,�"R#�.1��`�''���T'�:'�l����III�►T��l� <br /> PRW <br /> �CT ADDR�33: U r S� <br /> �EtILDIN6 AFtEA(ff residencial,new conatruction,remodel,or addldon) s� <br /> stJILDINl3 TYPE: �SFR-DE7ACH�D 0 SFR-ATTACH�R �DUPLp( L7 MIfLTI-�AMiLY-#�F UN1T5: Gl COMMERCIAL <br /> US�OF BUlLD1NG: <br /> . . �;��.�:����i��������e��.� R;�I�'�"Q������''. , <br /> • :. , <br /> � , <br /> C�NTRACT PRICE O�WORK:i O <br /> NUMB�R OF DEViCE3 if low volta e : <br /> F1R�ALARM? 0 Y�S ❑NO <br /> ASSaCIAT�D BUILDING PERMIT# if a 1►cable : <br /> pESCRIP'�ION OF WORK: � <br /> . , �GONYA�T i1+��AR11AA"f 10K ,. : <br /> OWN�R NAME: TENANT NAME ff Comtnercial : <br /> OW�IER MAI4ING AaDR�SSt s���r <br /> CITY W STAT� 71P � <br /> OWN�R PHONE: OWNEFi�MAIL: <br /> CON7RACTOR NAMf: O� rC <br /> CON7RACTOR ADDRE88: s�r G <br /> �. STATE aP �� <br /> CONTRACT'�R PHONE: � � �I CONTRACTOR EMAI�: <br /> CONTRACTOR LIC. REQUfREp:�I��N � ZL� CfTY OF E1/�RETT HU�SINE88 UC.if REQUIR�P:�I J <br /> P�iIMARY CONTACT: C1 OWNER ❑CONTRACTOR f�'�TH�R(Please Specify} t10 !¢ i �T?'J7�& _ _ <br /> CONTACT NAM�: CONTACT PNON�: � <br /> � (� � D CONTACT EMAII�: <br /> AGREEMENT 1 hsre6y adrtiry tAet 1 have read antf eYamfned this�pWlcetlon end krrow tAe seme ta be t�ue ana co►iect. R!!Drovfsions of/aws ancl orulnances ga+�sm1,�rnls rype <br /> oi wafc wUl De com�letad whetner specrlled hersN or not. The Qrentlnp o/e pem7it clos.s not pres�me to Qrw aufhority to violate or esnce!Hse provisPons of any otner stafe ar <br /> luca!!aw roguleting wnstivcUon or fhe Frefiom�ence ol aonsinKxlon, Thet 1 am autAor�ed by t1re owner o>tlrls property ta pedorm tlre wurk for whkh applicaGon ls meda end! <br /> comply with tAe Stele Candactas Law 18.27 RCW and 298.200 WAC. <br /> � <br /> ��pP1 ct�y of Evereu ofNc�ar use onry <br /> � P�RMlT# /0,0��0 <br /> /0 � �, � 0 ` ��Z <br /> Oumer! Zbd AQent Slgnatuf8 Rete (RDVIS�d 9/23/2018) <br />