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01I17/2018 15 : 43 #3107 P. 001/002 <br /> ELECTR.�CAL P�RMlT APPLICATION <br /> C1TY OF �V�R�7T PEt�M€T SERVICES <br /> 3200 CE�AR 57REET, �V�RETT, WA 98209 <br /> (P) 425�257�8810 ( FAX�25-257-8857 � (�) everetteps@evereti�nra.gav � wvwv.everettwa.gov/permits <br /> pROJECT S�TE II�FORIIIIATION <br /> PROJ�CT ADpR�SS: S I �� � <br /> �u1LDtNG AREA(if r�s�dential, new cAnstruction, remodel,or addition) �F <br /> BUEL,pING TYp�� 0 SF�,-DE7ACMED ❑ SFR-ATTACH�D ❑ DUP�FJC f� MULT!-FAMILY-#bF UN17S; ❑ COMMERCIAL <br /> U8�OF 9UI�pING: ^� <br /> ELECTRICAL APPLICATIQ�! 1[VF4RMATfON <br /> CONTI�ACT PRIC�OF V11�RK:$ � � <br /> NUMB�R OF DENICES if iow volta. e): <br /> F1R�A�ARM? Q YE5 ❑NO <br /> ASSOCIA7�A 6l]ILDING PERMIT# if a licable : <br /> � <br /> D�SCRIPTIQN oF WORK: <br /> CONTACT rNFORNIATlON <br /> pWNER NAI�IIE_ 1 TENAt�T NAME If COttl6nerci�l : <br /> OWNER MAILING ADnR�SS; srR�ar <br /> cirv ' • srAre ziP <br /> OWN�R PHON�; OWN�R EI�Afi.� <br /> CONTRAC70R NAME: /�,/ �-�1 � � ^ <br /> CONTRACTOR ADDR�SS: srrzeeY <br /> C ITY � 5TATE 'LIP <br /> CONTRAC70R PFiON�: L� �. , coN'rRacrOt��MAI�: <br /> CONTRACTol2 LIC.#(R�4UIR�D}: LD I� ClTY O��VER�TT BUSIlJ�SS LIG.�(REQUIRED):d� �p <br /> PRIMARY CONYACT: �]OWNER Q CdNTRACTOR L7�THER(Ffease Spocify) � ^ <br /> CONTACT iVAIUI�: CONTAC`f pHON�: �'�l ,z Z�f <br /> � �' � CONTACT EMAIL: <br /> AGRFEMENT:I hereby cFrti�y that 1 nave read snd sxamin�thls applicafion and know the sama to be frue anU torrecG AI!provrsions ollaws and ordinancr�s goveming this type <br /> of wak wiA be cornplet6d whether spocU/ed hararn ornot. TP�e granting of a pormit doas not presuma/o givo authorlry io violate or cance/tha provis;ons of any othar state o� <br /> local law regulatin8 consEruction oi tne pallormance o!const�uction. ThaE I am aulhorized by tha owne�of tA/s proparfy to porfo�m the work for whicP�appllcsf�on is made and! <br /> comply w/th the Stafe Contractors Law 9B27�CW and 2g6.200 WAC, <br /> Clty of Everatt Officlaf lJse Only <br /> /`� P�ft�n�r# <br /> f � � �L; / � ._� <br /> � <br /> Own uthorized Agont Signaturo Dat (R�vised 9/�.3/20?BJ <br />