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ELECTRI��L �E�NIIT APPLICATION <br /> GiTY OF EVERETT PERMIT SERVICES <br /> 3200 GEDAR STREET, EVERETT, VVA 98201 <br /> (P)425-251-8810 � FAX 42�-257-8857 � (E) ev�retteps@everettwa.gov � www.evere#twa.go�✓ipermits <br /> � -��c�,r�c� ���r� ���o�rn�aa�raa� .�.�.� <br /> F€�C;,�Ef:7AbDFtESS: i J��� '�4 l-l.i. �d <br /> i��t L�=- �L , � �'�._ (' r: ��T- F ��.�� `I`���-[�% j �_^ <br /> �,SJiLt�ING AREA(if residential, new construction, remodel,or addi�ien) SF <br /> BUiLDING TYPE: �SFR-DETACHED ❑ SFR-ATTACHED ❑ DUPLEX ❑ fvtULTI-FAMII_Y-#OF UNITS: ❑ COMNiERCIf,L. <br /> USE�F SL1lLDING: <br /> ELE+��'ii1C�,L APP�4.N�d�,�'It�l� lB�FORM.ATION <br /> CL11��RA�CT Pl210E OF WORK: $ �j(;�:' <br /> NUMB�R OF DEVIGES if low v�it�: �-- N s� — 6 <br /> F6t?E ALA�iM? ❑'YES �NO _ <br /> ,+ASSOCIl�T'ED BiJiLDiNG PE�MIT#(if applirable}: <br /> i3ESCRIPTIUN OF WORK: ���..•;`-� re;•� �\Er�� 1�� 'ti1 � ��' S k i?-�i C,i� C;;;��;T <br /> �t�F9'1".l��7° It��`S���t�"t1�N <br /> ��6Vf�EfZ NAME: ��Si;:.,i �.t�l�__ 1'��;,���T P5AIIME(If Commerci�lj: <br /> JV�IiVER MAILINGADDRESS: srReET I �ii�' �{v(,, �t�,,,; ��t��,E �L � � <br /> cm �+j C�F� \ STATE �'v pt zm ��cf�:���� � �� <br /> o�vr.���Ho►��: �j�5 - ��^�- `� G���s ovu�v�R e�nnaa�: 5i.l�.hi L�% �vv�tct5-r- � rv�-t- <br /> i,C3NTRAC70R NAME: i;k j�}4� K�(p�(� �{V L. <br /> CONTRACTOR ADDRESS: sr�eeT � �.. ;� �Q_LFZ l7 W {�il �i� ((� 1 <br /> ,_ CITY E V ^ \ \ STAI"L W.� ilp � � �(j i <br /> i.tJh1TRRCTOR PHONE: `t�-S '• �j 1�' `�l0�"� C�L`�JTF@AGTGFt��ifIAIL: �CZ('(,��1�'+�: c'-�IC i C7r`Vl Y��%', L�y�� �__._ <br /> �— ----�•�---- _ <br /> CfJNT'RACT'C}ta LlG.#(REQUIRED): L �X( (� � CITY OF�VEFdE1T BUSINE��LEC.#(RE�U14E0):����� <br /> _ �-�-�___.,_....�. �_._._.__... <br /> IFF`34��Af�Y COl�ITACT: []OW NF_R ❑CO�VTRACi"UR �t7TFlER�PleaSe SpeCify)_i�1`aT��.(, �1/1�f{.\i��-1,t� __ ^-- <br /> CONTACT NAME: CC1h�l,t'T RNG��: y,�:S - �"'�cj ' S 5�� 1 ---- <br /> �r-'`��Q-��'� �M1 V-�}� C�t�7ArT��REL: ��r" �r1�.C�K�G V'V� 1°1 i.�3 ,. L�J y'1i -� <br /> AGREEMENT:l hereby certify tYiat l have read and examined rhis application,and know the s�,r.e 7o be true and correct. Aff provisions o(laws ar.0 ordinances yovern�nU ti�rs type <br /> of work wi;;de comple[e�i whet'rrer specified,7erein or not. Th,e grenfm�of a permit Joes nct preswn�to yivc.auihoriiy to violate or cancel the provrsions ef���y otfier stai�o� <br /> loc.a!law regu/ating construction or thQ perrormarres of construction. That I am aufhnrized by!ha owriar of thrs pro�eriy to potform d�e work f�r wnich appiication rs made a,rd I <br /> compJy with ihe State Contractors Law 18.2i RCW and 296.200 vVAC. <br /> City of Everet:Ofircia!Use Only <br /> �' PERMIT# ��� <br /> �/ �� �; E � ��- -�30 <br /> � <br /> O�uacf Authorized Agent Signature Date (Revised 9i?3/2016) <br />