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10I30/2017 09 : 41 • #2215 P. 004�'004 <br /> � <br /> �LECTRICAL P�RlIAIT APPLICATION <br /> Ci�Y OF EVERETT PERMIT SERVICE�S <br /> 32Q0 CEDAR STREET, EVERETT,WA 88201 <br /> (P)425-257-8810 J FAX 425-257-�85�7 � (E}everetteps�everettw2�.gov� www.everettwa.gov/permits <br /> , , <br /> .. <br /> , <br /> , <br /> 1��C1����'>��T,"�'�,t��'Q�t�;AT.IQ� . ' <br /> �Ra,Ec�r Au��ss: �O � <br /> BIJILDINC/1R�A(if residential,new constructi0n,remodel,of addition) $F <br /> BUILDING TYP�: C]SFR-pETACFiEP ❑SFR-ATTACH�D Q DUP��X 0 MULTI-FAMILY-#OF UNITS: O�OMM�RCIAL <br /> USE OF BUIL.�ING:,s�f�- <br /> ..,. , , 4..,. <br /> .,� <br /> ;: <br /> ,� <br /> ����'T'�1.��1�.I�p,�:L��iA"�"I.�D1���!I���TiQN`'`� '. <br /> CONTRACT PRIC�OF WORK:S p�S�0 � <br /> NUMB�R OF DEVICES if low vott�a e : <br /> FIR�ALARM? Q YES 0 NA <br /> A330CIAT�D BUILDiNG PERMfT# if a IEcebte : <br /> DESCRIPTlON OF WORK: I � � � '� <br /> J'� .f ,� O <br /> , ,. . .:. :. , '.`„ :`::CAMTACT I:Mi�0r��1TIQl+r. <br /> � . <br /> OVYN�R NAME: � T�NANT NAM� It CommArclat: <br /> OWNER MAILING AqDRE8S: s�ee►' G <br /> cro srn'PE [/V aP � <br /> OWN�l�PHONE: �.� OWN�R ENAtI,: <br /> CONTRACTOR NAM�: ~ � � C <br /> CONTRAC70R ADDR�SS: s�rrt�Er O 1�� <br /> GRy STATE � � <br /> CONTRACTOR PHONE: CON7RACTOR EAIAII.: <br /> CONTRACTOR I.IC- REQulR�P: CRY OF EYERET7'BUSINES3 L�C.�(R�flUIR�D): <br /> PRIMARY CONTACT: q OWNER ❑CONTRACTOR []OTHER(E'lease Specify) <br /> CONTACT NAM�: CONTAC3 PHON�: ' � <br /> /q-�4 � � Q coNT�►cr E�a�: <br /> qGt�EMPlY7`J heroDy oa�tify that!Aave raad and e�camined this appUcatiort and know tha same to ee true and aom+rl- Alf provisions of laws aMi Ord/nanaes govemtnp mis�pe <br /> oI work wil/he completed whetAer specrllad henun or not. The 9���9��Pe�d�+�P�+��9�8u�°^'�t°vivlete or esncel tire p.ovisions a1 enY afner state a <br /> local!ew roguladng con8d�ctlon ar the l��nance of cvnSb�IcNon. That!sm autAakeci Ry llw owrrer of Uii3 P+�Aa+1Y to P�rfwm the wark for wlfkh epDlicdtlon is maQe a�1 <br /> comply wr7n fAe Stete Conb�ctors Lew 1�a7 RCW end 2&s.2oo WAR <br /> Clty oiEvero#Olficf�!Use OnIY <br /> PERMi'f# <br /> /a 30 � � �- I 0 — Z �� <br /> orm � ehan�d r�em s�yneture t�te �Re�i�d 9rr�2orsJ <br />