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y <br /> CLECCTF J1CAL_ PER rIT APPUUC " TON <br /> • CITY OF EVERETT PERMIT 40VICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> (P)425-257-8810 1 FAX 425-257-8857 ] (E) everetteps@everettwa.gov I www.everettwa.gov/permits <br /> PROJECT SITE INFORMATION <br /> PROJECT ADDRESS: b U \✓ e-;-_,, ,,,,tt- o i g- q(D 5 E> co( G 5 3, ?5 <br /> BUILDING AREA(if residential, new constion, remodel, or addition) SF <br /> BUILDING TYPE: 0 SFR-DETACHED 0 SFR-ATTACHED ❑ DUPLEX ❑ MULTI-FAMILY-#OF UNITS: ❑ COMMERCIAL <br /> USE OF BUILDING: 5 ? / -' YM\ ( ( 1 `, c_ �� _ <br /> • ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK:$ Cam, ()CD C� <br /> NUMBER OF DEVICES(if low voltage): <br /> FIRE ALARM? 0 YES ❑NO ' <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIPTION OFfWORK: � L9C_� 5 C-e ? c.}O CAA, lCP L U <br /> �c L`c, ` (fin _ CI p4T /)C <br /> • <br /> CONTACT INFORMATION <br /> OWNER NAME: Ih V�A (t 5 TENANT NAME(If Commercial): 564,f,),/ 5 , <br /> OWNER MAILINGA ADDRESS:/ J STREET // �' 11 /� <br /> t '� C-N CITY (-QJ STATE 1.9I$.. ZIP 90 7{6') <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: ,(/UI/l.O,t--6_,, -B,.._ki-e 4 41-1%4--0 c�sq-16,—C�� <br /> CONTRACTOR ADDRESS: STREET C � S ,204 <br /> €L -r CITY STATE ()J ZIP 7-0 1> <br /> CONTRACTOR PHONE:02 7/ �--4e) -3 CONTRACTOR EMAIL: 13 " k% c.._y- , DJ, ji ;17; ti,./� \ <br /> CONTRACTOR LIC.#(REQUIRED):D Oa 5 L 77/ D CITY OF EVERETT BUSINESS LIC.#(REQUIRED): Q q '-E 7i <br /> PRIMARY CONTACT: VI-OWNER ❑ CONTRACTOR 0 OTHER(Please Specify) <br /> CO TACT NAME: CONTACT PHONE:ak U 6 ?(5-9 U U 3 <br /> CI <br /> ((-,_, ),,\) CONTACT EMAIL: Ic , kic Dvtt - c/ cc <br /> AGREEMENT:T hereby certify tha have read and examined this application and know the same to be true and corltct. All provisions of laws and ordinances�gpeming 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 1 <br /> comply with the State Contractors Law 18.27 RCW and 296.200 WAC. <br /> City of Everett Official Use Only <br /> FEE <br /> PERMIT# <br /> 0 er/A Agent Signature Date (Revised 10/12/2015) <br />