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7?f.yG .:1�V:.7 �`}.11;�„',{� �f 1.���9i�.{� �{,����'�� d�I.r.li�.��Gd�7.Ki <br /> ELECTRICAL PERMIT APPLI+CATI0IV <br /> CITY OF EVERETT PERMIT SERViCES <br /> 320d CEDAR STREET, EVEFtETT,WA 98201 <br /> (P}425-257-881 D � �AX 425-257-8857 �{E)everetteps a�everet#wa.gov j www.everettwa.gQvlpermifs <br /> _ <br /> PROJECT SfTE IN�ORMATf�N <br /> PROJEGT ApDRESS: � C� Q,� �j'�"r , ;��.�'-�^ <br /> SUILD11�tG Af2EA{if residentiaE,new cansiruction,remadei,or addition) S� <br /> BUILDINC TYPE: O SFR-DETACHED O' SFR-ATTACHEIJ O DUPLE3C O MULTf-FAMII.Y-#OF UNITS: O CQMMERCIAL <br /> USE(}F BUILDING: <br /> v � <br /> ET. RICA� APP ICATION INFQRMATION <br /> CONTRACT PRtCE OF WORK:,'� i� "� p� f,' <br /> NUMBER OF DEVICES(if law vo{tage): I�, �� <br /> �'IRE ALARM? o YES o N� '� � <br /> ASSOCIATED BtlILDING PERMII'�# if appticab`I`ej:����� <br /> DESCRlPTION OF WORK: <br /> � -� ��'1�'t 't2.r " " �,Jtt'C� �� <br /> CONTACT I N FQRMATi ON <br /> OWNER NAME; ��{,�G.. �.)._,i��� TENANT lYAME(if CommerCial}: <br /> OWN�R NUIILING Ai}DRESS: srn��-r L,-��� C,r (�,�, � ':� <br /> GiTY L,/ 4� � ��'� STATE � �ZIP � <br /> OWNER PHONE: OWNER EMAlL: <br /> CQNTRAGTOR NAME: t � '`���'' <br /> CONTRAC70R ADDRESS: sraeEr rG-`L� �� � <br /> CfTY � � S7A'fE� 7J�q <br /> CONTRAGTOR PHONE: CONTRACT R EMAlL: <br /> CONTRAGTC3R LIC.#(iZEt2U1RED�: � �j- ,� Cl'iY OF EVEl2ETT BUSiP1E5S L[C.#(RE4UIRE ): ' �.!) J 9 <br /> PRIMARY GONTACT: o OW NE€2` fl CONTRACTC3R O OTH�R(Please Speeiiy) .� � ' <br /> �ONTACT lUA6RE: GONTACT PfiONE: i„�'�,� `�C.� � �~�L-, �� � `r <br /> ���.�-.-� <br /> �,, -�?,,^r`� Cf1NTACT EMWL: 'l c� � �4 n <br /> j '�1� �,- <br /> AGREEMENT.•t here6y certlty ihaf l have rEad and examtRed fhis appficatiun and know the same to be true and co�recL Al!prnvislons of laws and arfmances goverrring this type <br /> of wak wiN 6e completed whefher specified herein or nof. The granting qf a permit does not presume to give authaity to valate or cancef the provlsions oiatty other sfafe or <br /> loca!!aw regulatirg constructian nr the performance t�f construction. That l am authorized by�he owner of this property to perform the work for which appGeation rs made arnl! <br /> compfy wrth the State Contraetors La�v 18:27 i2CW a»d 29B.2p0 WAC. <br /> City oFEverett�cia�Use Onty <br /> PERMIT# <br /> �.� �1�� It � E �� �� _ 3 <br /> Owrier/Authorized gent 5ignaRure � Qake (Revised 9lZ3/2016) <br />