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17�27�2oi� 7i : 2i #2s�o P. 00irooi <br /> EL�CTRICAL PERMVII�` APPLICATION <br /> CiTY�F EVER�l�T P�RMIT S�RVIC�S <br /> 3200 CEDAR STR�ET, �V�RETT, WA 98201 <br /> (P) A25�257-8810 J FAX�25-257-8857 � (�) everetteps@everettwa.gov � www.everettwa,gov/permits <br /> S � PROJECT SI�'� INFORMAT�ON <br /> PROJECT AApR�Ss: � O <br /> �Utl-I�ING AREA(if!'esldential, 116W constfuCt1011, remodel,or addition) �F <br /> aUI�DING TYPE: ❑SFR�pE7ACHEp ❑ SFR-ATTACHED- ❑ DUPL�X ❑ MUL71-FAMI�Y-#OF UNITS: ❑COMM�RCIAL <br /> USE�F BUILDING: d/k <br /> ��ECTR�CA�.APPL�CAT�ON INFQRMAT�ON <br /> CONTRACT PR[C�OF W�RK:$ �j <br /> NUMBER O� Q�VICES if IoW volta e : <br /> FIRE ALARM? ❑YES ❑ f�0 <br /> ASSOCIATED BUI�AING PEI�MIT# if a licai�le : <br /> pESCf21PTION OF WORK; / � �� r <br /> /� cr i�Nt.. P�t,v <br /> CONTAC7 INFORMATION <br /> OWN�R NAME: (> 7�NANT NAME If Gommercial : <br /> OWNER MAI�ING ADDI2ESS: sTReEr Q / 6 J <br /> crrv srAr� z�P �•1•4 <br /> OWNER PHQN�: ,'�� � O a.3 OWNEiz�MAII-: <br /> COhI�RACTOR tVAM�: ��l �. ���/C, <br /> CQNTRACTOR ADI7R�SS: srReEr �J l <br /> CITY ETATE 21P /�(/ <br /> CONTRACTOR PHON�: � CON7RAGTOR�MAf�: O <br /> CONTRACTOR�.IC.#(REC2uIFGp): C17Y OF EVERETT BUSIN�SS L1C. REQUIR�D): � <br /> PRIMARY CONTAC7: Q OWN�R ❑CONTRAC70R ..�OTH�R(Please Speclfy} <br /> CONTACY NAM�: CONTACT PHON�: � „� � �� <br /> r <br /> UQ i L� CONTACT EMAI L: <br /> AGREEM�NT,I hereby cortify tnaf 1 hava raad and exdmined thls applicafion and kno�v tn�sarne[o be true and c❑rrect. AJt provlslons oP/aws and orr�inances qoveming rhis typa <br /> of work wil!be completed whetharspecifieQ herein or nof. 7he grantrng of a permit does noP presume fo give authority to violate or cancal tha provis;ans olany otherstate or <br /> rocal law regulating construct;on or 1�e penormance of construetkn. Thst I am autHerh�ed by tha owner of this prnpsriy to perform the work for wRieY,appllcatlon is made and 1 <br /> comply wlih the stafe contractors Law f8,27 RCwanr!298,200 WAC. <br /> City af�verg#Ofi/clal Use Onfy <br /> P�RM�r� <br /> // .2 /� E ��-< < -- �� S <br /> Ow r Aurhorized Agent Si�natura Date (Rbvised Qi23/20�6) <br />