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=1 .t r aECTR CAL PERMIT AOVLICATION <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 I www.everettwa.gov/permits <br /> ROJ `ll' SQ 'E QNIFORl dATIIQ i s.: <br /> PROJECT ADDRESS: -pzg ` 1 <br /> BUILDING AREA(if residential,new construction,remmade,, or addition) SF <br /> BUILDING TYPE: 0 SFR-DETACHED 0 SFR ATTACHED 0 DUPLEX 0 MULTI-FAMILY-#OF UNITS: )'COMMERCIAL <br /> USE OF BUILDING: 5Gi5 • <br /> ELEC'RQCAL APOLQCATQ®N QIR➢et)it AtQON. <br /> CONTRACT PRICE OF WORK:$ 450e7 -C",L-4-, <br /> NUMBER OF DEVICES(if low voltage):, 6asoadT �,f ,ox 0 <br /> FIRE ALARM? 0 YES 0 NO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): E/8O3-al <br /> DESCRIPTION OF WORK: // . <br /> G tic' 1�oar/. .- d OWr7S/ 'L.,�I/!¢7�C /4149 &I-4X-fa C.,I1zO(!!/ <br /> . N A <br /> S�CJJ TACT_INFORMA'1'10[�1. :. : :.. <br /> OWNER NAME: -7---C-.'1Olrn9" <br /> liUG S �e..C.. TENANT NAME(If Commercial): / ,� _ y C74-7( <br /> OWNER MAILING ADDRESS: STREET <br /> CITY STATE ZIP <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: j jj a.,-,,,Ja <br /> CONTRACTOR ADDRESS: sTREer fO .jk v/0X QQ <br /> CITY it fC� STATE (OO" ZIP 7CJ3 <br /> CONTRACTOR PHONE: 405 �„ 1576?) CONTRACTOR EMAIL: /Y9ndee-ied-V/ -ba 6!'Bale-, .A <br /> CONTRACTOR LIC,#(REQUIRED): wyea`'<e(2S3ee CITY OF EVERETT BUSINESS LIC.#(REQU • 1): <br /> PRIMARY CONTACT: ❑OWNER CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: 40s— 3n 7 /6-5---o <br /> u ... 0/Z8 CONTACT EMAIL: <br /> AGREEMENT:T hereby certify that I have read and examined this application and know the same to be true and correct. All provisions oflaws 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 1 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 /> iS .......„ . <br /> gAdj?ib PERMIT# <br /> 7/7 8 E 1�o3 - v <br /> OwnerlAuthorized Agent Signature Date (Revised 10/12/2015) <br />