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tLECCTR CAL PER JiffA PLICAT O <br /> i1*:00,--A-- , <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> (P)425-257-8810 J FAX 425-257-8857 j (E) everetteps@everettwa.gov j www.everettwa.gov/permits <br /> PR a JECT SITE INF 0 RIMA '1ION .: <br /> PROJECT ADDRESS: P\CI I,l)1(,— Au,--e_ <br /> BUILDING AREA(if residential,new construction,remodel,or addition) 2 ; SF e W <br /> BUILDING TYPE: 0 SFR-DETACHED 0 SFR-ATTACHED 0 DUPLEX 0 MULTI-FAMILY-#OF UNITS: 0 COMMERCIAL <br /> USE OF BUILDING: - <br /> ELECTRICAL APPLICATION INFORMATIO <br /> CONTRACT PRICE OF WORK:$ S 0 , 6 O <br /> NUMBER OF DEVICES(if low voltage):, <br /> FIRE ALARM? 0 YES 0 NO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIPTION OF WORK: <br /> 1-e-rn p PNt -fr--- pol-(_, . <br /> Cif z, :,:. ; -:, -: : CONTACT:INFORMATION. ::.: . : • - _ <br /> o. J 64-co C( Lsc '( ��TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET (0 (o s,e, . 4`� t c'614 <br /> crrr trYb &-.4 .1• 1 l Q STATE LJ� Via <br /> ZIP --)6 <br /> NOWNERPHONE: (1 /5)316-- JJ Y OWNER EMAIL: UJB,s÷- (cp( 1 <br /> CONTRACTOR NAME: O u..„-„,,._Pay-. l'___e,�Y ciCt ( ( 4-/tf cH e,) <br /> CONTRACTOR ADDRESS: STREET <br /> CITY STATE ZIP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> CONTRACTOR LIC,#(REQUIRED): CITY OF EVERETT BUSINESS LIC.#(REQUIRED)S3 d1/2 <br /> PRIMARY CONTACT: 0 OWNER CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: <br /> 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 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 296.206 WAC. <br /> City of Everett Official Use Only <br /> FEE <br /> PERMIT# <br /> r ()s11Li F11(60 ( - Ib <br /> Owner/.U . •gent Signature Date (Revised 10/12/2015) <br />