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-/----miiiwyi iLE TRIIC,kL PERMIT A _I ��TJI®N
<br /> A! ,`r CITY OF EVERETT PS
<br /> 3200 CEDAR STREET, EVERETTERMIT , WAERVICES 98201
<br /> (P)425-257-8810 1 FAX 425-257-8857 I (E) everetteps@everettwa.gov] wvdw.everettwa.gov/permits
<br /> -ki4EGT SATE INFO► l a",167:.7!T
<br /> PROJECT ADDRESS: 1-1"7( 7 S, 7 ' /Po i/.v a I.49 2 G 3.
<br /> F
<br /> BUILDING AREA(if residential,new construction,remodel,or addition) 8 0 SF •
<br /> BUILDING TYPE: IYSFR-DETACHED 0 SFR-ATTACHED 0 DUPL 0 MULTI-F,MILY-#OF UNITS: 0 COMMERCIAL
<br /> USE OF BUILDING: I?j . 1 r/I cher
<br /> ELECTRICAL A.00100.A.- ION FOREW.01ON
<br /> CONTRACT PRICE OF WORK:$ '2. , 5-00
<br /> NUMBER OF DEVICES(if low voltage):<
<br /> FIRE ALARM? 0 YES VNO
<br /> ASSOCIATED BUILDING PERMIT#(if pplicable):
<br /> DESCRIPTION OF WORK: E 2 4/),/c,u sq- F y`1 l 'LA // /-/Qa f et-S
<br /> Batt ,,� • Li1h1- s' A v,f/pis , A-AId 5q“wi 0/41` but /etL -
<br /> C��aNTA,_ -_ T INFORMATION.
<br /> OWNER NAME: Peh.l9I$ /1-- �
<br /> '- e. i 4,... TENANT NAME(If Commercial):
<br /> OWNER MAILING ADDRESS: STREET 4,?/ 7 '" If r- Av.(
<br /> EVs.v-0-#" CITY °61 STATE `S92./V 3 ZIP
<br /> OWNER PHONE: '+x„5-- Ce)/ -6 74711 W OWNER EMAIL: Vi01,/t?a Veer c.S 2 oto () /7�c1 4,/ <'`t-,. a
<br /> CONTRACTOR NAME: 0 LA/14 e i,
<br /> CONTRACTOR ADDRESS: STREET •
<br /> CITY �, STATE ZIP
<br /> CONTRACTOR PHONE: J2)`Td j --0 / CONTRACTOR EMAIL: SS kt,`'
<br /> CONTRACTOR LIC.#(REQUIRED): CITY OF EVERETT BUSINESS LIC.#(REQUIRED):
<br /> m��,.-..,,,Y..-.:,.-..�M T...�,. .,, .w _ _-._.. .n....�. ..s-�....,n....,.._,�- �.�,.ww. :,... ....-a .,..,_:�� :x,....,w,�.� ,__.. ,..k ._,...... ..,.�, �..M.M K<.... ...—,._-____y..,._,.,
<br /> PRIMARY CONTACT: OWNER 0 CONTRACTOR 0 OTHER(Please Specify)
<br /> CONTACT NAME: CONTACT PHONE: 112_c- SC.// -6 ?
<br /> 4'4'-
<br /> ' ti h/S /11,2,1 1-' CONTACT EMAIL:w di,/4 C v.9 4 S 10/o eff2 a fri,-r a,-/ cc
<br /> AGRFFMENT.-T hereby certify that t 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 lam 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 /> LOC _ . _ . .
<br /> PERMIT#
<br /> i
<br /> � 4..
<br /> --7 .,-,--7"/";--
<br /> Owner/Authorized „..,,,,,.:„.7,
<br /> /Z-/ - zO7 F �Zbl -OO
<br /> Agent Signature` Date (Revised 10/12/2015)
<br />
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