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LNETAL PERMIT AHATIN <br /> CITY Y EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT,WA 98201 <br /> (P)425-257-8810 1 FAX 425-257-8857 j (E)everetteps@everettwa.gov] ww .everettwa :ov/permits <br /> N. PROJECT SITE INFORMATION <br /> PROJECT ADDRESS: 3 .. , u <br /> BUILDING AREA(if residential,new construction,remodel,or addition) SF <br /> BUILDING TYPE: 0 SFR-DETACHED .0 FR-ATTA HED 0 DUPLEX 0 MULTI-FAMILY-#OF UNITS: CI COMMERCIAL <br /> USE Of BUILDING: <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK:$ ' — <br /> NUMBER OF DEVICES if low volfase)a <br /> FIRE ALARM? 0 YES r"Na <br /> ASSOCIATED BUILDING PERMIT# if as slicable. <br /> DESCRIPTION Dip WORK: IMININNINIMMENIMIIMMI <br /> at - t ' .44 <br /> 111 0) <br /> CONTACT INFORMATION <br /> OWNER NAA+#E: � <br /> 1 k 4r�i ',i O i TENANT NAME(If Commercial t <br /> OWNER MAILING ADDRESS srnscr <br /> , E. STATE \A.)A ZIP oiti aoz <br /> OWNER PHONE: <br /> CONTRACTOR NAME: Lt t y i <br /> CONTRACTOR ADDRESS: sTeerr Gt.e.tet :"" t 3,)Krr r Q ?I''Vi11 c ` <br /> CIT' i r VI ay. STATE A' 4 P t;� t <br /> CONTRACTOR PHONE: O- % S-- 5 L CONTRACTOR EMAIL: g , ; it <br /> CONTRACTOR LIC, '' REQUIRED): i...IC114 Te L 1 Sio'!J Q <br /> CITY Of EUEttE'17 BUSINESS LIC. REQUIRED): --% ""j ei <br /> PRIMARY CONTACT: Q OWNER I d-CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: I CONTACT PHONE: <br /> v\ "' "f0$,t.0, CONTACT EMIL: CC., £ @ e , <br /> A(,REEMENT:t hereby certify that t have teed end examined this a <br /> of work will be completed whether specified herein or not, The application an�Y:lstrow the seine to be of a omit does not presume �e and coive act All provisions of(avis and ordinances governing this type <br /> local law regulating construction or the,performance of construction. Tat l am�authorized by the owner of this property obl ate or cancel the which�applicationiother state or <br /> comply with the State Contractors Law 16,27 FCW and 296.200 WAC. perform thework for which es made and t <br /> City of Everett Official Use Only <br /> 1. <br /> 111 ' <br /> t <br /> ...,--iii..... . PERMIT <br /> E ibt ( ttA <br /> +fit tit/tart r...Trent g store <br /> Date (Revised 9/2312016) <br />