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EL.ECTRI�,�L PERMIT APPLIC�4TIUN <br /> CiTY OF EVERETT�ERMtI'SERVICES <br /> 320C}GEDAR STREET', E�IERETT,INA 9820�1 <br /> (F)425-�57-8$1(? � FAX 42�-z57-$857 � (E}ever�:tteps@everettwa.gou� www.ever�tt�ra.gov/permits <br /> ... � , <br /> ' ` � PROJECT SITE,:INFORM/�,Tit�N � <br /> : . ;.,.._._ ::.._ . ..��. .. ��' � ,., ,:.. _,� <br /> .._,�.�, �.�. . . ,M. ...�, .. . <br /> PiYfJJECT ADDRESS: �j L�LS,� +�j�'/.�.S`j"� J�I.S��y`+f G5 � ��G� �'T� � �.-- <br /> BIJILpING AREA(ff residenfial,new construction,remodei,or addition� �F <br /> BltIt;DING TYPE: ❑SFR-DETACWED ❑SFR-ATTAGHBD L7 DUPI�EX �MULTI-FAMILY-#qF UNITS: ❑GOhANIE:RCI:RL <br /> USE OF BUILQENG; • <br /> , . . �, : <br /> ,,M;. � <br /> ' � ELECTRICAL APPL.tCATi�N�tNFQRMA7"I�N � ° <br /> �.. � a <br /> ��NTRACT PRICE OF WORK:$ �`j. <br /> N�#MBER OF DEVIGES if low voita e). <br /> FIRE I�►LARM? C)YES NQ <br /> ASS�CIA"fED BIJILDING PERMiT# if a licabie . <br /> DE�GRIPTiON t)E WQRK'R , �;:. ' c..d. � � <br /> � � � _ � � _ <br /> CflN'TA�T lNF�RM1�tT�ON ^ <br /> OWNER NAME: ' t?�--� TENAN7"NAME�if Gommercial}: <br /> OINNER MAILING AQbRESS; �ra�r <br /> GiTY� ST�iTE ��ZIP <br /> 01NNER PHONE=: OWIVER EMA1Lc <br /> C4NTRAGTOR NAME; �"" }c- �.,. f'� ��. �. <br /> CQNT�AGTOR ADDRESS: ��rt��r ,.� :�'�'�" .� � `�y ..�" � <br /> GIiY "��f: � 4 r�/ ` TATE �- ZIP CJ� <br /> ct�ur�a�TOR�MON�: -- ,rr � � }� CCti+tTRACTOR EM�11L: �,,;�'�` `"�;,"'�..-�t'� .� ,�f, �,, <br /> CQNi'RACTQR 1.IC.#((2ELIUIR�D): ���rG�� ' GITY OF EUERETT BUSlNESS LIC.#REQUERED:� V. <br /> PRIMARY CONTACT.• ❑DUUNER f�CONTRACTOR ❑�TNEF2(Pl�ase Specify) <br /> CO[�ITI�C'F Is1AME: Cl?NTACT PHONE: �.{j�a�- �,r`c�!-�"��.��` <br /> _�_...�.-• , <br /> c.:� � ;�- cor�Tacr��nar�: .�r� ��.�� S ,�s-�� ��� <br /> AGRE€MEhiT't hereby cerfily th 1 f�ave rea�and e�carriined#his applieatron and know the same to b�true and r�orrect AYI provisions of laws:and orztinancex g�veming this type <br /> af ryorK tvi/!6�compieted w�te�herspeciked.hecein o�nvt. The granting pf a permi#does rrot presume to give authority�:vfolate or car�cef(tr�provisians od aqy othe�sta#e�or <br /> lacet law regulatr'ng cGnsGvction ar th�peri��nce Qf eonstruction. THat G am autharized by the awnet�01�thts prope�y to perfirrm 1he woric for wla7cM.appticaY�qrr�s made arrd! <br /> compfy with 1Fie State Contractors Law?$.2T RCW and ZQ&.20A WAC. <br /> City of Ever�tt Q�eial Ilse Only <br /> ....���..., <br /> PERMIT# <br /> � �� : �.� �- ,� E � 62� I C�� <br /> r[Auth�riaed AgenE Signature Oate {Revised 9f23/2�11�) <br />