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ECTOJETT <br /> RICAL PERMIT AP ICATION <br /> 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 /> PROJECT SITE INFORMATION <br /> PROJECT ADDRESS: CY pup K---T.e. IA L)Goo SIP2,d(jam) <br /> J <br /> BUILDING AREA(if residential, new construction, remodel, or addition) I G Ts(0 SF <br /> BUILDING TYPE: 0 SFR-DETACHED 0 SFR-ATTACHEDCO0 DUPLEX 0 MULTI-FAMILY-#OF UNITS: ®" MMERCIAL <br /> USE OF BUILDING: Pow-1. I( L 7_-_,L-nJ' - O r tI <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK:$ il, 0 L 0 <br /> NUMBER OF DEVICES (if low voltage): // j 4 <br /> FIRE ALARM? 0 YES 1221<10 <br /> ASSOCIATED BUILDING PERMIT#(if applicable): J!� , <br /> DESCRIPTION OF WORK: 11 ;,U(_ ce \ LO C) P t�,:'l�:ie- TU i2 1Jb�t� <br /> An, Po eTA <br /> A <br /> CONTACT INFORMATION <br /> A <br /> OWNER NAME: UKK(LT c) SC-HOOL. r TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET 9 O I �C7�^^�1)p_orK) Th /' \ { 'J <br /> Cf: - <br /> ,, CITY C V b'12t 1 1 STATE l/V A ZIP ! [wog <br /> OWNER PHONE:�-tR p t ji " I Zi%`( -,/OWNER EMAIL:al-c jJ j�J/(1 f�° !,4()'LC(L7-'- e.) <br /> tU( <br /> CONTRACTOR NAME: CC fl�;J C LJ C t f��t <br /> CONTRACTOR ADDRESS: STREET 90 Sc lC 9 LI 0 (l <br /> CITY r�, K_ `l_lI VY)O0+)h STATE 1-1L))3 ZIPO Ol V <br /> CONTRACTOR PHONE:3C- -..6G,_->6 <br /> CONTRACTOR EMAIL: CL.1t �jtJ� Mc �.3 �2LC con <br /> CONTRACTOR LIC.#(REQUIRED):M�}�i ••••) -(--9(1:)) <br /> IVt L CITY OF EVERETT BUSINESS LIC.#(REQUIRED): Q k-13 <br /> PRIMARY CONTACT: 0 OWNER tE CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: Z0C, -L(' - <br /> CONTACT EMAIL: <br /> A SLaJ <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 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 /> (1)1,0 • ()5 <br /> PERMIT# <br /> Owner/Authy_anzed Agent Signature Date (Revised 10/122015) <br />