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LECTR L PERMIT T kYLlCAT ON <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 1 (E) everetteps@everettwa.gov 1 www.everettwa.govlpermits <br /> P• EJECT SITE ff F AT9 <br /> PROJECT ADDRESS: 2 f 17 (_O M 1-KD F <br /> BUILDING AREA(if residential,new construction, remodel,or addition) SF • <br /> BUILDING TYPE: ❑SFR-DETACHED 174 SFR-ATTACHED 0 DUPLEX 0 MULTI-FAMILY-#OF UNITS: 0 COMMERCIAL <br /> i USE OF BUILDING: S <br /> ELECTRICAL APPLICATION 9NF`.RMAn c p ._.. ... • <br /> CONTRACT PRICE OF WORK:$ E.0/0 <br /> NUMBER OF DEVICES(if low voltage): <br /> FIRE ALARM? 0 YES 0 NO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIPTION OF WORK: -41-"-e t- e o LE E-}-Q <br /> -. C®NlrAer:PAF.gaMATII®N.. ::.:. . <br /> OWNER NAME: L.-112)F .-Ty s('-0 (L TI o A/TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET <br /> CRY STATE ZIP <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: vt( FLIQj <br /> CONTRACTOR ADDRESS: STREEr ,6.l& I F!.-Ff j/(/(r-- "1"-- <br /> /� nl 2 <br /> CITY 1V! 1Yy l / - STATE 1AA ZIP 4,m <br /> CONTRACTOR PHONE: 3 b -Lc 5-9 0 LI CONTRACTOR EMAIL:vA 5(.E C. /C )6014 L.'0 ,(.-1)14-1 <br /> 03-2- 7—zV6 05-3r/ <br /> CONTRACTOR LIC.#(REQUIRED): 1/i� <br /> ;L 13,.) CITY OF EVERETT BUSINESS LIC.#(REQUIRED): <br /> , :n _ . <br /> —.. <br /> PRIMARY CONTACT: 0 OWNER J CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: 2,�O s 0 i-7 <br /> • <br /> i (.`i eo e CONTACT EMAIL: v4£LB i C'�P *HOD . cf.) <br /> ksi <br /> AGREEMENT. T hereby 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 l 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 18.27 RCW and 296.200 WAC. <br /> City of Everett Official Use Only <br /> FEE <br /> PERMIT# <br /> 3 57 <br /> Owner/Aut.•rized Agent Signature Date (Revised 10/12/2015) <br />