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ELECTRIGAL PER�I�T' A�PLlCATION <br /> CITY�F EVERETT PERMIT SERVICES <br /> 32d0 CEDAR STREET, EVERETT, WA 98201 <br /> (P)425-257-8810 � FAX 425-257-8857 � (E}everetteps@everettwa.gov� www.everettwa.gov/permits <br /> PI���E�'t'S!'f'�.�I�!lFt)RM/1T:10N __ <br /> Pt�K?���'t'ADDRESS: �I 1 C0 � _ �� . �: • . _ _ <br /> _ _ : <br /> BUtLDING AREA((firesidentfal,new construction�remodel,or atldtti�t� ___ __ �� <br /> �tJILDlNG TYPE: SFR DE.TACHED [�5FR-ATTACHED ❑DUPLEX �MULTI-FAMILY-#OF UN(;t�; ❑COMMERCIAL <br /> � _ <br /> �8E OF BUILDtNG: <br /> _ - �:t; �_. . <br /> ; _ , ' ����"IAR�t�lf».��1���+�#'�t'��i. :ii�'�i'�t�Tt�t�' . _ <br /> _ __ <br /> _ _ <br /> CONTRACT PRICE OF WORK $ d ,� <br /> NUMBER OF DEVICES i�'low vs�T'� �'; <br /> -:; <br /> _ <br /> FIRE ALARM? �YES ❑NO <br /> _ __ <br /> +��a�OCIATED BUILDING PERMIT# if a<, Iicable„. <br /> _ <br /> DESCRlPTION OF WQRK: ` » ` <br /> : _ . <br /> ° +���±1T�LC'�"iI�1Ft���"�`t!�N <br /> - .. <br /> t�tl+t�NAME: - �� ;�l'�; ; � TENANT NAME:tf�at�ttrr�rClaM e <br /> OWNER MAIIING AQDRESS: srR�eT ` < ;. � _ _ <br /> �..�/+ t, �J t� <br /> CfIY .""G� .�. . .. . . STATE �/v::.. ...21P �� . . <br /> .::. ._. �+.� �� �::�. , .. . . . ._ ::.:.._ ,: .�.' . .. .... � <br /> OWNER PHONE: ` = OWNER EMAII�: _ <br /> _.. <br /> Gt�NYft,1�C7QR NAME: ;' `:� . _ _ <br /> , <br /> �3�h1TfiA�TtxR ADDRESS: sraEer <br /> � '. �, �t��. . . . <br /> ca�' , , '` , �r�°� �=` � ' .� :::2C7� <br /> CONTRACTQR PHONEt ' � CONTRACTOR�t4!I+�IF;� , " <br /> . NN <br /> CONTRACTOR LIC.�f��lUl�#`���. , _ � _ ' <br /> � -�d� � CI'�'�`OF EVERETT BUSINESS LIC, `R�ti1�p� , -' <br /> PRIMARY CQNTACT: p OWNER CONTRACTOR �OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE; <br /> � y �L� ��� �� <br /> . . .; <br /> � '�i�w��� ,_ CQNTACl'EMAIL:� �i' '�?� �(�rn <br /> _ <br /> AGREEMENT:l hereby ceAify that;have resd and examined thfs appiicaUon and know fhe same fo be(rue and correc[. All provisions o(faws and ordinances goveming this lype <br /> of work wi1J be compteted whefher spec/fled haretn or not. The granGng oI a permit does not presume to glve authodty to vlolafe or cancel fhe provis(ons of any other sfate or <br /> loca!law regulating conshuction or the per/ormance o(consbuctlon. That i am authonzed by the owner ot fhis property to per/orm!hs work lor which appilcation is made and t <br /> comply wifh(he Siafe Confractors Law 18.27 RCW and 296.100 WAC. <br /> Clty of Everett Olficia!Use Only <br /> ..y,��,+�..�, <br /> ' PERMIT# <br /> .� �`�k����:�u►�� � �o ._ t� E 1�-O S - 1 g�-- <br /> . <br /> QN�rkerlAutho�r�d Agent Si�n�ttp�� 17afe (Revlsed 9123/2016) <br />