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<br /> ELECTRICAL PE1Z�I1/[IT APP�ICAT�ON
<br /> � CITY OF �VEf��TT PERMIT S�RVEC�S
<br /> 3200 CEDAR STREET, EV�RE7T, WA 98201
<br /> (P) 425-257••�810 f FAX 425-257�8557 � (�) ever�tteps@everettwa.gov � www_everetfwa.gov/permits
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<br /> PROJEC7AUbRESS; 3�JH 3�Sf DI'IVL
<br /> BUf�,bING ARE,q(if r�siclential, new ConstruCtion, r�modei, or addifionj,�� SF
<br /> BUI�.DfNG TYP�; ❑ SFR-D�7ACH�D L 5FR-ATTACHED � DUPLEX � N(ULTf-FAMILY-#OF 11NlTS: � COMM�RCfq�
<br /> US�OF SUILDING_
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<br /> CONTRACT PR1C� OF WORK; $ 50p.0� �
<br /> NUMB�R 01� DEVICES (ff low voita e):
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<br /> ASSOCIATEb BUfL,CIING P�RIVIIT# (if a licabfe);
<br /> DFSGRIPXiON OF WQRKr Hook up 6L.DG 18 o�f ten�p power
<br /> Please caI1263-872-G051, ask for Alicia, for payment whan permit is ready Thank youJ
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<br /> OW�FR N,4�n�; Pofygor� Nomes �
<br /> TENANT NAME !f Gommercial :
<br /> OWNER I�A(LINGADDF�ESS: srR�Er 1162q� S� 5th St Suite 200
<br /> ci�v �ellevue srArs WA
<br /> OWN�1�PHONE: 425-5oG�770� a�P 95�05
<br /> - OWIVEF2 EMAI�.:
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<br /> CONTRQCTOa NANf�; Gafrlel^EleCtf'iC W�ShfllgtoCt LLC
<br /> CONTRACTOR ADdRESS: sTReer�O� VBIIeJ/AVA NW Suite 106
<br /> cirr P�Y�IIup sTaTe WA
<br /> CONTRAGTOR PHONE� 253-872-�0�1 ziP 98371
<br /> cotvTr�cro��mqi�.; ac��ntele@gw�Usa.com
<br /> CONTFZACTOR�,IC.#(REQUIREb): GARN�EW$64KR C1TY OF EVE�ETT BU51N�55 LIC,�t(REQUIaED); O�J29O9
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<br /> PRIMARY CON"TACT; ❑
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<br /> �W�E� � CONTF�cACTOR ❑pTH�R(Please Specify)
<br /> CONTACT NAIVIE: CON7ACT pHON�;
<br /> Paul Vantol 253-273-7D64
<br /> coNTAcr EMAI�: pvanto!@gweusa.com
<br /> AGREEMENT.�!h�eby pg��/fy ryJat!have le2d end examined this app/icalion s71d knoW tfie sam�to 6E t!'Ue and Correct. A/I provls/ons of laws and ordrnances gOvrm/ng filis fype
<br /> oF work w1!!be complet�d whether speciffed Merern or nof. 7hQ grentfng of a psrm�t does no� resume
<br /> loCallew I'9gufafiny cor7sl/UCtron or Pno per/prman�ol constrUCtion. jh�t 1 am&uthorized by fhe owne o�h Se ro erfy fo vrolate or cancer the provrslons ofany o�her state or
<br /> Comp/y wlth fhe Stst�Contractors Law 18.27 RCW enU 296.z00 WAC. p p Y AGIYorm thB work rpr Wh��h$pp�ICafion js meds anU I
<br /> Cffy Of Everg�(O�cid/US6 Only
<br /> • " PE(�MIT#
<br /> ownerlAuthorized A�entSi nature � � � I� o ��0��
<br /> ate (Rev/ssd 9/z312o76J
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