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E�CTRIGAL PER�UIIT AP�ICATION <br /> : C1TY OF EVERETT PERMIT SERViCES <br /> 3200 CEDAR STREET, EVERETT,WA 98201 <br /> (P)425-257-881 d ( FAX�#25-257-8857 � (E)everetteps@evere##wa.gov � www.evereifwa.govl�etmits <br /> PROJECT S{TE 1NFt)RMATI4N <br /> PRQJECT ADDRESS: -�'�► <br /> S� SW ��er-e,�{- <br /> BUfLDiNG AREA(if residentiat,new construction,remodel,or addition) SP <br /> BUiLDING TYPE: SFR-pECACHED C7 SFR ATCACHED D DUPLEX ❑MULTi-FAMILY-#OF UNITS: 0 COMMERCIAL <br /> USE i3F BUlLDl4�iG: <br /> ELECTRICAL APPI.ICATION<iNFORMATI�N <br /> COPlTRACT PRtCE OF WORK:$ LJ��Q <br /> ft�UMBER OF DEViCES(if!ow voitage: <br /> ��RE A�ARM? Q YES 1�NO <br /> ASSOCtATED BUILDING PERMiT#(if a ticabie : <br /> � DEBGRiPTt4N 41F WORK: ; Y ' , <br /> y � <br /> _ - Ct3NTACT �NFORA�ATION <br /> OVt►�IER tVAME: 7ENANT NAME f{f Commerciai�: <br /> OWEVER M;4ILWG AF'lQRESS: sr�er <br /> C� STATE aA <br /> OWNER PHONE: OWNER EMAiL: <br /> CONTRACTOR NAME: - ,r-W�ti,n <br /> CO�iTRACTOR ADDRESS: srn�r � (h�;' V �b 13" � I� � � <br /> crrr �M r -v,� SFATE L�A z�a�'}�� �7 Q <br /> CQFUTRAGTOR FHONE: 3�a c�5'' �'j�-1�� CQIdTf�AC70R EMAIL: C.��a.r��tL�t�Uz`u��'z�nT'. GC� <br /> CONTRA,GTOR LlC.#{REt�UIRED): C�A�Ztl1 E Q�'�.G�T CITY OF E'1/EitETT 6USINESS LIC.�{REi�UiRED}: �; q t p <br /> PRfMARY CQNTACT: CI OWNER �CONTRACI`Oft l�OTHER(Please Spec�fj+) <br /> COi�TACT NAME: CONTACT PHONE. �� �r�, � c7�3 S <br /> ��t�Y`�CLt`1C3G� l�u.c�t'�i�r�7i`� CONTACT E�1tIL: (�,:�nG,t��G:.��cz-�.�7 e,t'Z�'-t,�rn <br /> AGREE141ENF:T heretry cetify that f have read and examined fhis apprt�tion and know the Same tp be bve and Co�ct AOprovisions ofiaws and o�dinances goveming ihis <br /> fype of work wi1!be eomptetetl whetherspecified he�ein ornot The granSng ofa parm#sloes not presume to�ive authority to viotate oresncef the provisions ofany othersfate or <br /> local faw repulafing ccutstructian or flte perfotmance of constructian. That i am aufhorizect by the ovfrnerof this properfy to perform the worklor which appl7cation is made and t <br /> compiy wifh the State Contractors Law i8 27 RCW and 296.200 WAC <br /> City of Everett Officia!Use Only <br /> FEE � <br /> �� ✓ <br /> PERMIT# <br /> 1 � �� ��-' ``�� <br /> OwnerlAuthorized Agent Signature ate <br /> (Revised tU112/2015) <br />