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.-- 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 /> .: <br /> PROJECT SITE INFORMATION' <br /> PROJECT ADDRESS: L 3 4 9 SO kr S co F r,,,&.1 St <br /> BUILDING AREA(if residential,new construction,remodel,or addition) SF <br /> BUILDING TYPE: 0 SFR-DETACHED 0 SFR-ATTACHED 0 DUPLEX 0 MULTI-FAMILY-#OF UNITS: COMMERCIAL <br /> USE OF BUILDING: c , C ., <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK:$ `�0 OD oa • <br /> NUMBER OF DEVICES(if low voltage):, / <br /> FIRE ALARM? 0 YES ;I NO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIPTION OF WORK: <br /> . ,i _ -t <br /> CONTACT INFORMATION. <br /> OWNER NAME: TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET <br /> CITY STATE ZIP <br /> OWNER PHONE:zo.c')...c? c( OWNER EMAIL: <br /> CONTRACTOR NAME: S CYl a . t...., LC <br /> CONTRACTOR_yl�� ADDRESS: STREET (-U' (a ( < 1 0.J.,,C1v--tb-_ Gy�j Q <br /> i, e ,,,,,.., CITY STATE (3 c ZIP4 4 (. 1 <br /> CONTRACTOR PHONE: V..ng —S7 3€s‘22 CONTRACTOR EMAiL: <br /> CONTRACTOR LiC.#(REQUIRED):S Wl 5S 6S L A 31 ' ) CITY OF EVERETT BUSINESS LIC.#(REQUIRED):OY c6) I <br /> PRIMARY CONTACT: D OWNER 0 CONTRACTOR 0 OTHER(Please Specify) <br /> CON CT NAME: CONTACT PHONE: s 3 Ltoc 2. V0 , <br /> WiJL CONTACT EMAIL: <br /> AGREEMENT:T hereb certify that 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/am authorized by the owner of this property to perform the work for which application is made and! <br /> comply with the State Contractors Law 18.27 RCW and 296.200 WAC. <br /> City of Everett Official Use Only <br /> FEE �` <br /> 02. ` _ O <br /> PERMIT# <br /> -411414 `N d. t,.....t.j dil.....4s114"-.1.-..., t. - ls�zc_) 1 1 DCP - \2k <br /> Owner/Authorized Ag: t Signature Date (Revised 10/12/2015) <br />