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Ju1291610:04a Vickie 3606914838 p.1 <br /> �,,;(Z.�-9�- C'c2��` � C%��-� ��-C� �P1� �--�%��� a� ��1ClC� � <br /> ELEC�`F�1CA� PERMtT �4PPL1CAT14N -T--��,��� <br /> GiTY OF EVER�TT t'ERMIT SERViCES ��"`?`�S � <br /> 3200 CE�AR STREET, EVERETT,WA 58201 <br /> (P}425 257-SS10 �f FAX 425-257-88�7 ) {Ej everefteps@everet[wa.gov} wvwv,everettwa.govlpermits <br /> • PROJI�CT S1TE 1NFORMATIOW <br /> PROJECT ADDRESS: � <br /> Bl.FILDI�G AREA(if residential, new construction, remodel,or addition) SF <br /> BUILDlNG TYFE: �I SFR-�ETACHED ❑SFF2-A7TACHED ❑ DUPLEX ❑ MUL71-FAMILY-#OF UN ITS: COMMERCIAL <br /> USE OF 8i11LDING: ,��� <br /> ELEGTRICAL 1�PPLICATIO{� INFORMEIITlON � <br /> CONTRACT PR{CE OF WORK:$ <br /> NUMBER OF DEVlCES (if low volta e : <br /> F�RE ALARM2 ❑YES ❑ NO <br /> ASSOCfATED BUIL��t�fG PERMIT#(if epplicable): <br /> �ESGRIPTION OF WORK: �, �,�' <br /> CONTACT [NFORMATt�N <br /> OWNER 1VAlVIE• �(If CornmerciaF): <br /> OWNER MAILING ADDRESS: STR'cET ..Q <br /> ��rr STAFE 7�p 3 <br /> �WNER PHONE• OWNER EMAEL• <br /> . .. . .. ..... .. ... ... ... ..... . ... . _ . .. <br /> .. _ . ..._.._.. _.. .... . .. . ... _.. <br /> CONYE2AC70R NAME: � �L„Q_ <br /> CONTRAC70R ADQR�SS: srrzEEr +� ��"f <br /> CfiY STA7E ��,�(r <br /> Z!P <br /> CONTRAC`F'OR PHOI�[E: � C�M7RACTOR EMAIL: �i E G�-YYIQ 1'1 � �d �t�[ .i� <br /> CONTRACTOR L[C.#(R�QItfRED): t � GITYQF EVERE'FT BUSIiVESS LIC.�{ft�QUIRED):(�'J� � <br /> . .. . ._......�.......... . <br /> _....... ...... ..... ...... ........... ... .._...... ._.. ._...::..... .................. ..�..... ......_ .:...... . .... <br /> . ._...... ... ---...... _..�............ . . . <br /> PRlMARYGONTACT: ❑ DINNER �@�fT'RACTOR ❑ OTNER(Please Specry) <br /> CDNI'A T INAM�: � CONTACT PHONE: � � �_,..(� � <br /> ,Z,� COIVTACT EMAIL: <br /> .S�R�EP/iENT:T hereby ce�fy fhat 1 Fave read and examined this ap,olicafion and krov�the same io be true and correeL AU provisions oflaws and vrdenances goveming fhis <br /> fy,oe a/avaic will be oempleted whether specrfied harein o�nat. The grarrtrng aFa permit does not presume fo give authority to violate otcance!the p!ovisions vf any other state or <br /> lQ�a!law ragulating censfruction or the performarfce of consGucfion. Thai/am authorrzc�d by fhe otrrner o{this prope�ty fo perform fhe wo�k for w,7fch applicafion Fs ir,ade ar,d! <br /> comcy with ths Stafe Contracfors Law 18.2;RCSN and 29S.2D0 W.4C. <br /> City of Everetf Offrcral Use Only <br /> FEE <br /> � �� ,� <br /> P ERMIT# <br /> _ �lJt�f'1`�4�1Y�-.-�'�-1 � I � <br /> � <br /> OwnerlAuihorizetf Agent SiBnature , , Dafe (Revised 90/92fz095) <br />