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'1ECTRIC L PERMIT fi- -3UUCCA ZION <br /> a 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 J www.everettwa.gov/permits <br /> r . PROJECT SITE ONFOIRiviATOON <br /> PROJECT ADDRESS: 4003 5 , C <br /> BUILDING AREA(if residential, new construction,remodel,or addition) iJ/A SF <br /> BUILDING TYPE: 0 SFR-DETACHED 0 SFR-ATTACHED 0 DUPLEX 0 MULTI-FAMILY-#OF UNITS: 0 COMMERCIAL <br /> USE OF BUILDING: afrD c 2_, jL,� <br /> ELECTRICAL APPUIC .TIOM likIFtRIVIATION <br /> CONTRACT PRICE OF WORK:$ N.VA — <br /> NUMBER OF DEVICES (if low voltage): t-/A <br /> FIRE ALARM? ❑YES WI° <br /> ASSOCIATED BUILDING PERMIT#(if applicable): l%-1/A <br /> DESCRIPTION OF WORK: l hi at La. t�lr"�t-c; 6-1-6C-117--AC-4 <br /> CONTACT 9�9)i=ORMA` IOItI <br /> OWNER NAME: Cir t>FF TENANT NAME(If Commercial): c';' <br /> OWNER MAILING ADDRESS: sTREEr 3Z <br /> CITY f U `r T STATE it4 A ZJP 48,Z,c?,j <br /> OWNER PHONE: 42-5-25' OWNER EMAIL: kee71-@.�/ —-T-GJ4 cco <br /> CONTRACTOR NAME: OOATy C <br /> CONTRACTOR ADDRESS: STREET 3 ZOO ( <br /> CINEVC42-e-TTSTATE A ZIP c leIZ / <br /> CONTRACTOR PHONE: s -3 jj-v 4.<1 7 CONTRACTOR EMAIL: .5CA yt.y L(a exASIZerritLit 4 66 V <br /> CONTRACTOR LIC.#(REQUIRED): n!/A% CITY OF EVERETT BUSINESS LIC.#(REQUIRED): 14 <br /> PRIMARY CONTACT:0 OWNER RCONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: ' 'a CONTACT PHONE: 47.S -3Z..f,— d(o4 i <br /> 0 `,,-W et-L, CONTACT EMAIL: si`,61rL-D t3L2� @ ;Ly4 ,C,cV <br /> AGREEMENT:Thereby 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 I 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 /> /� <br /> V✓•t 4-2_4-2011 F 00(4-110 <br /> OwnerlAutho ed Agent Sig Date (Revised 10/12/2015) <br />