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ELECTRICAL P�R�iT A�'PL����`�C)�: <br /> CITY OF EVERETT PERMIT SERViCES <br /> 3200 CEDAR STREET, EVERETT,WA 98201 <br /> (P)425-257-8810 � FAX 425-257-6857 � (E)everetteps@everettwa.gov( www.everettwa.govtpermits <br /> p'�+tiCr:!"�:t�"t`;������_, .:�`�'��i4t � <br /> PftQJE�T ADDRESS: ' `� �L ' _ __ _ <br /> � .. � <br /> B�tt,F��NG AREA�I�residentlal,new construction,remodel,or addltG�} S� <br /> _. <br /> BWLDtNG TYPE: SFR-D6TACHEQ ❑SFR-ATTACHED C7 DUPLEX ❑.MULTI-FAMILY-#OF UNITS• ❑COMMERCIAL <br /> U5E OF BU1lD1NG: <br /> `� "` _' ,;< , - `;'�.CYr�.�ir������p'+����ir��►����'�^����Ipi�'1"l�!'� <br /> CONTRACT PRICE OF WORK: $ C7 .a' <br /> NUMBER OF DEVICES if fow voita e : <br /> _ <br /> FIRE ALARM? ❑YES ❑ NO '' <br /> ASSOCIATED BUILDlNG PERMIT# if a plicable : <br /> DESCRIPTION OF WQRK, �!'J T•�,�, <br /> __ _ _ _ _ __ _ _ _ ___ _ _ _ <br /> _ ;... , � : _ <br /> .� ., ,, <br /> ,; :G��l�i+�'.�I+��L�������►� <br /> _ _ <br /> OWNER NAME; � TENANT NAME �#Camtt�er��a k <br /> . _ _ <br /> _.:... _ <br /> OWNER MAILING ADDRESS. sraeer ,� . �-�� ��,,,,; � <br /> ... ... . ...._. GRY .' ':�'' .... .... .._ _. STATE �T ... ZIP -"'< . ' <br /> ftWNER PHONE: _.:,... . OWNER EMAIL: _......... . <br /> . <br /> GClNTRACTOR NAME: , ; . . ` R.�, <br /> _ . ,: <br /> CONTRACTOR ADDRESS: sTrteeT _ <br /> 1 `. � ��t� <br /> _ _ <br /> ciTv g7aT� � _. ,zip Zv <br /> �ONTRACTOR PHONE, "^ ""1 : �C?A17�i�T+l�t EMAIL; . t ` , yyt <br /> : _ <br /> _. ,.. ,_ .. <br /> Gt?N`t`}��7"t�R UC. �.R�E�l1tR�#��:���= �}' ' �Cl�i CITY OF EVERETT BUSINESS UC.#F2�;3t��£?t ' <br /> . .. <br /> . _ -, - <br /> �RtMAR.Y CON7ACT: O OWNER CONTRACTOR ❑OTNER(Pfease Specify) _ _.. <br /> '���'�ACT NAME: CONTACT PHONE: <br /> �� ��� ��. <br /> n �. . <br /> � ��C. CONTACT EMAlL: : -. "� , ��'C� #CaC�� <br /> -. <br /> AGREEMENT.•t hereby certify tflat t have read and examined thls sppficelion and know fhe same to be true and conect. A!1 prov(slons of/aws and ordinances goveming thrs type <br /> of work w11!be complefed whelher spect�ed hereln or not. The granGng o/a permll abes nof presume to glve aulhorfty to vlolafe or cancel fhe provisfons of any other state or <br /> local law regulating conslrvcNon or the performance o/consfructlon. That I am authorized by fhe owner of thls properly to pertorm the work ior which appllcatlon/s made and t <br /> comply wi(h fhe Stafe Conlracfors Law l8.27 RCW and 296.20Q WAC. <br /> City of Everett OfflcJal Use Onty <br /> PERMIT# <br /> .�.._. ���`��a:��� q�21. t� E ���`� - � `� ( <br /> t3'r�e�°/lM1Utitorix�d Age�t�tgnatur� Data <br /> _ (Revised 9/23/2016) <br />