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OIL PLECTRICAL PERMIT APPLICATION <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@everettwa.gov I www.everettwa.gov/permits <br /> ',T;R ., i#00JECT SIT0NFORMATION. . <br /> PROJECT ADDRESS: Liy 317d- AVL ve-47- <br /> BUILDING AREA(if residential, new construction,remodel,or addition) SF <br /> BUILDING TYPE: 0 SFR-DETACHED 0 SFR-ATTACHED 0 DUPLEX 0 MULTI-FAMILY-#OF UNITS: <br /> NITS <br /> : ❑COMMERCIAL <br /> USE OF BUILDING: , W 134:41- 60 f 4ef' pcip <br /> ".? ELEC )004:741413410 914:040.04,0100%,' <br /> .. <br /> CONTRACT PRICE OF WORK:$ ,CPO <br /> NUMBER OF DEVICES (if low voltage): <br /> FIRE ALARM? 0 YES WINO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIPTION OF WORK: � �� J�,�J /41:41-2. 5/21/5L plyYj f <br /> CONTACT INFORMATION <br /> OWNER NAME: 6 f e_ liwr 4c 7 TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET V2 ( 37/4 /W - j,�ie�} �`�� wCf EIV <br /> n �^ CITY /��r STATE Wit ZIP FVZ73 <br /> OWNER PHONE: 1/l�J 131(7! 3 7I)6- OWNER EMAIL: <br /> CONTRACTOR NAME: C(ed`e�j E -e.Chlt - / <br /> CONTRACTOR ADDRESS: STREET/73/ 2c&i / 1 t,` / 9/61-447-- <br /> CONTRACTOR <br /> '/(� /y�J <br /> los <br /> 7‘d- ?e43"2--- <br /> CITY c`7G'r 14M STATE ZIP (61.4(J <br /> CONTRACTOR PHONE:%2 5 76& /p �� 7ONNTRACCTOR EMAIL: <br /> CONTRACTOR LIC.#(REQUIRED): cRK J /X / CITY OF EVERETT BUSINESS LIC.#(REQUIRED): <br /> PRIMARY CONTACT: fiOWNER 0 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE:lac-31(7-371./ <br /> CONTACT EMAIL: <br /> AGREEMENT.Thereby certify that!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/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 /> PERMIT# <br /> 1f-72a 0 g2 <br /> Owner/Authorized Agent Signature Date (Revised 10/12/2015) <br />