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"W. ELECTRICAL PERMIT "LIC TI 0 N <br /> I�►' CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 I (E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> PROJECT SITE INFORMATION' <br /> PROJECT ADDRESS: ( 3 0 ( 3CR 4A aue Ev.Q ret( <br /> BUILDING AREA(if residential,new construction, remodel,or addition) 6o SF <br /> BUILDING TYPE: 0 SFR-DETACHED 0 SFR-ATTACHED 0 DUPLEX 0 MULTI-FAMILY-#OF UNITS: 9.COMMERCIAL <br /> USE OF BUILDING: Ik . A. <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK:$ 3 00 v 92 <br /> NUMBER OF DEVICES(if low voltage): <br /> FIRE ALARM? 0 YES 0 NO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIPTION OF WORK: c 02 L. `D6-. o-e c s \n C <br /> CONTACT INFORMATION <br /> OWNER NAME: ,C C1/4.7 L ?: l e-e.<0_ TENANT NAME(If(Commercial): v A- A-0 CL., <br /> OWNER MAILING ADDRESS: STREET / fp Q t,U S S� \,LR 4 S v< a.� g (7 <br /> CITY rt./ ) STATE / ZIP '(/ t�3 <br /> OWNER PHONE: 2t(o Z� _( Zoe V OWNER EMAIL: <br /> CONTRACTOR NAME: cp 5 v e <br /> CONTRACTOR ADDRESS: STREET a Z I CP f 00 S- s <br /> CITY e L/- C e STATE CO ZIP `D-a,0 to <br /> CONTRACTOR PHONE: ((I SC-2 CONTRACTOR EMAIL: -e.c]e 6"C .°/eC-- <br /> CONTRACTOR LIC,#(REQUIRED): lM \ }CQ S S O 3 3C(L CITY OF EVERETT BUSINESS LIC.#(REQUIRED): 3S3 <br /> PRIMARY CONTACT: 0 OWNER 0 CONTRACTOR ETHER(Please Specify) � �„ <br /> CONTACT NAME: CONTACT PHONE: 2c� ( 8 ( S f 7 SP <br /> c--- c 5 ^-e r CONTACT EMAIL: rt C c cQ,Q k.. S'Ir7 v►( • Csrtiv\ <br /> AGREEMENT:T hereby cerlifythat I have read and examined this application and know the same to be true and correct. All provisions of laws and ordinances governing this <br /> type of work will be completed whether specified herein or not. The granting of a permit does not presume to give authority to violate or cancel the provisions of any other state or <br /> local law regulating construction or the performance of construction. That 1 am authorized by the owner of this property to perform the work for which application is made and I <br /> comply with the State Contractors Law 1827 RCW and 296.200 WAC. <br /> City of Everett Official Use Only <br /> FEE <br /> Sc - <br /> PERMIT <br /> # <br /> r a E I go 4-0 30 <br /> Owner/Authorized Agent Signature Date (Revised 10/12/2015) <br />