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0 0 <br />CELGC` RICAL P R iN F APPUCQ`1 N <br />u CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />(P) 425-257-8810 1 FAX 425-257-8857 1 (E) everetteps@everettwa.gov I www.everettwa.gov/permits <br />(PROJECT SRTE ON1FORGi A u'OP(ri9': <br />PROJECT ADDRESS: 3-7 <br />BUILDING AREA (if residential, new construction, remodel, or addition) �C�o SF <br />BUILDING TYPE: ❑ SFR-DETACHED <br />SFR-ATTACHED ❑ DUPLEX ❑ MULTI -FAMILY - # OF UNITS: ❑ COMMERCIAL <br />USE OF BUILDING: �iti='el Lf1�✓L <br />__.. <br />E) Ci?CTRICryALAPPLUCATIOMINFORM ®III <br />CONTRACT PRICE OF WORK: $ ODb <br />NUMBER OF DEVICES (if low voltage): <br />FIRE ALARM? ❑ YES ❑ NO <br />ASSOCIATED BUILDING PERMIT ## (if applicable): <br />DESCRIPTION OF WORK: W 1 Rt F-d12 /APC9, /AJ Cr2 944ti <br />Zc3 �IfW "r . I`�5z`V�fi' D -P�4T V i-r6Ne-Al Sn: r4� VI-1 LC-r S b cc-'Oe <br />Cei--A vZ- LIe-,147" /,'' -ek-'icrl Z6av—j <br />CONTACT INFORMATION . <br />OWNER NAME: C. Ll�I l�Rd�«Ty S&Ls-lfif DAl.S TENANT NAME (If Commercial): <br />OWNER MAILING ADDRESS: STREET <br />CITY STATE ZIP <br />OWNER PHONE: N OU " 390 ` 3 U7te OWNER EMAIL: <br />CONTRACTOR NAME: <br />CONTRACTOR ADDRESS: STREET tfe6IQ U5'r"L- <br />CITY �NG}}c'J [s }1 STATE ZIP -1 p 2�IG <br />CONTRACTOR PHONE: LM5- iW9 -7132- <br />1CONTRACTOR EMAIL: FCjv metzet-ecK V-i<1 1 C G1"141L. Cc-" <br />CONTRACTOR LIC. #(REQUIRED): FC-J "e-eL t3 '-1 'd CITY OF EVERETT BUSINESS LIC. #(REQUIRED): % <br />PRIMARY CONTACT: ❑ OWNER tff-CONTRACTOR ❑ OTHER (Please Specify) <br />CONTACT NAME: <br />.J�N L %t N �� N'I�'e�- <br />CONTACT PHONE: 4)25" 7 FS"/ i f 3 2— <br />CONTACT EMAIL: <br />AGREEMENT. Thereby 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 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 />FE <br />RMIT isoq-6y3 <br />Owner/Authorized Agent Signature <br />Date <br />(Revised 1011212015) <br />