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#141P„,,,,......A - ECS ICAC, PERMIT _ CATIO <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©everettwagov I www.everettwa.govlpermits <br /> PROJECT SITE INFORMATION' <br /> PROJECT ADDRESS: JCSO,), ()E t\o 6 /-v E' E(/P_Y-4) <br /> BUILDING AREA(if residential,new construction,remodel, or addition) r.,e6ie vtt..,Gt I SF <br /> y...-1/0 0 <br /> BUILDING TYPE: 0 SFR-DETACHED 0 SFR-ATTACHED 0 DUPLEX 0 MULTI-FAMILY-#OF UNITS: 0 COMMERCIAL <br /> USE OF BUILDING: ` ,i-. ' / <br /> ow- <br /> 411 ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK:$ co(t) • <br /> NUMBER OF DEVICES(if low voltage): <br /> FIRE ALARM? 0 YES LWNO 1 <br /> ASSOCIATED BUILDING PERMIT#(if applicable): C 7 v t —00 <br /> DESCRIPTION OF WORK: 0 -U-k 1 LA-5- . --.5 -�V tik r-"` ctsf'V1r'e-2 <br /> cl,fiv r d c1141,4c.."-s-J <br /> CONTACT INFORMATION - <br /> OWNER NAME: V I, - TENANT AME(If Commercial): <br /> OWNER MAILING ADDRESS: j\rd coy-C:6 <br /> 151 0).. 'R L(,e II /' '" - .( -.. -- <br /> CITY tv y 1$ �� 1‘,0 STATE �la. Z[P 9 PP�70 <br /> OWNER PHONE: 4) Jai 3 - _J OWNER EMAIL: V <br /> CONTRACTOR NAME: S Lip cA r.-c- L`\- C <br /> CONTRACTOR ADDRESS: STREET C 15 P 5 4i,..... A) <br /> CIN VIAA-4(7.5)C., • STATE 9 ZIP "Fe? 73 <br /> CONTRACTOR PHONE: GA?5-0..3 l 0114 CONTRACTOR EMAIL: sO b irk 40_, L,CO 1.4....., <br /> CONTRACTOR LIC.#(REQUIRED): ,S Coe.LE OE 5-0 D \ CITY OF EVERETT BUSINESS LIC.# r QUIRED): (03 , <br /> PRIMARY CONTACT: pleiWNER 0 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: lig 1,.a3 9 .'3[fj <br /> coif <br /> � OSOA. CONTACT EMAIL: goer k 4A0c .G <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 /> . ( cO <br /> PERMIT# <br /> Ownvi '71,M-' /674PY1 9 - Pi-- i ? E I qbel - t 0 (--( <br /> thorized Agent Sig - Date (Revised 10/12/2015) <br />