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cLECTRICAL PERMIT Ar�l�'LIGATION <br /> CiTY C7F EVERETT PERMIT SERVICES <br /> 32�0 CED,�R STREET, EVERETT, WA 98201 <br /> (P)425-257-8$10 � FAX 425-257-8857 j (�}everetteps@ever�ttwa.gov� wv�w.everetfwa.gov/permi#s <br /> PRt�JECT S�TE INP{��14��►'T�CgN <br /> PROJE�T At}DRESS: �✓ t.,,�� `""� i'�ie�-V1 `�- <br /> BUILDING AREA(if residential,new construction,remodel,or addition) SF <br /> BUILDlNG TYPE: ❑SFR-DETACHED R-ATTACMEO ❑ Dt1PLEX C7 MULTi-FAMILY-#OF UNITS: ❑COMMERCIA� <br /> USE OF St11�DiNG: <br /> ELECTRICAL APPlICAT�ON INFORMATtQN <br /> caNrRacT PRicE a�woaK: � , _� <br /> NUMBER OF DEViCES if low valta e): <br /> FIFiE ALARM? C�YE5 E�NO <br /> ASSOCIATED BUILDtNG pERMIT# if a licable : <br /> u�sc��P-r�ora o�wo�aK: Y`-�.�� -}--- �,-t--�-`�- °�- vf f C ��� Y��'�'.�- �.r°'y� <br /> CbNTACT IN�ORMATION � <br /> 4WNER NAME�. �,�'1�,`� '�--<`,�{,�.�'�, V1,,,��TENANT NAME If Commerciat : <br /> OWNER MAILING ADDRESS: s-r�ee r � � r y�G� /'�}� ��.�. <br /> CRY ���'� �- � STATE �..� ZIP �/ �� <br /> OWNER PHONE: , S "'T��-• ? OWNER EMAIL: <br /> coN-r�c7a�r Nann�: �'�'-��►�'�:3 trt-ti. -�'�.�--c.�v� � �-- t��-�--t'� <br /> CONTFFACTQR ADDRESS: sTR�eT �-~�� I� �``"�''�'� � . �•'� ' <br /> CITY ���� C��, � V ( �LC.____� STATE �,���"�. ZIP� �S �� <br /> cotir�cro�prtoNe:�-. W�A���`�V� CONTRACTOR EMAlL: ������°i�� -� ��J '��CCf'�',t�'� <br /> CONTRACTOR LIC.#(REQUtRED):���}�3��'���B'}�" ���-�-;� �,,.� CtTY OF EVERETT BUSfNESS LIC.#(REQUtRED): o �- . � <br /> PRIMARY CONTACT: I,7 OWNER �ONTRACTOR ❑OTHER(Please Sgeeify) <br /> CONTACT E: CONTACT PHONE: ,, � �� 1. " ' <br /> '. :� ��t.,�'� CONTACT EMAiL: j )� , � /� `; ��� ' <br /> AGREEMENT.-!hereby certrfy ehat I have mad and examined this applica6on and know the same to be true and correcF. A(f provisrons of lews and orrlinances goveming fhis type <br /> of work wil!be compiefed whather specifred herein or not. The granting of a,oermrt does nof presume to give aufhority to violate or cancel ihe provisions of any other state or <br /> local Iaw regulating construction or the performance of consf,vcfion. That 1 am authonzecf by the owner of fhis properiy to perfo�m fhe work for whieh applicatian is made and l <br /> comply with the State Contractors�aw 18.27 RGW and 296.2QQ WRC. <br /> Cify of Everett�fficiat Use Only <br /> PERMlT# <br /> � � ��%' .�-- i -�� -_�� � �6� -- 2 <br /> � � %' � �� <br /> ' Owner/Authoriz gent Signaiure Date (Revised 9/23/2016) <br /> i <br />