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05/09/2016 MON 16: 14 FAX 4252521666 CM Heating 0002/003
<br /> RECTRICAL PERMIT AILICATION
<br /> A►' , CITY OF EVERETT PERMIT SERVICES
<br /> 3200 CEDAR STREET, EVERETT, WA 98201 •
<br /> (P)425-257-8810 I FAX 425-257-8857 1 (E)everettepeceverettwa.gov www.everettwa.gov/permits
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<br /> PROJECT ADDRESS: LCAj psK1 cp �`
<br /> BUILDING AREA(If residential,new construction,remodel,or addition) SF
<br /> BUILDING TYPE: 0 SFR-DETACHED N4 R-ATTACHED Q DUPLEX ❑ MULTI-FAMILY•#OF UNITS: in COMMERCIAL
<br /> USE OF BUILDING:
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<br /> �c 'it i'n , lr x:'
<br /> CONTRACT PRICE OF WORK; $
<br /> NUMBER OF DEVICES(If.low voltage):
<br /> FIRE ALARM? 0 YES ❑NO
<br /> ASSOCIATED BUILDING PERMIT# (If applicable :
<br /> DESCRIPTION OF WORK: Q �[1 LADO-UL
<br /> ran Cl -ki\11-1P,CYN_ LSAIA-S
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<br /> OWNER NAME; � � )( TENANT NAME[If Commercial): r...
<br /> OWNER MAILING ADDRESS; STREET pa`j ,sh\ _CiR �
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<br /> CITY STATE ' YIP qqae.a
<br /> OWNER PHONE; 14 ak&j OWNER EMAIL;
<br /> CONTRACTOR NAME: ( T\ c,
<br /> CONTRACTOR ADDRESS; STREET `
<br /> L_.J w
<br /> CITY`` STATE ZIP
<br /> CONTRACTOR PHONE:l 91(" CONTRACTOR EMAIL: f j• 12,_,Ja( S rt • (4:2)t
<br /> CONTRACTOR LIC,#(REQUIRED; !e•
<br /> �(�-1 t CITY OF EVERETT BUSINESS LIC #REQUIRED):1, Q • r
<br /> PRIMARY CONTACT: 0 OWNER l(pONTRACTOFt 0 OTHER(Please Specify)
<br /> CONTACT NAME: f _ CONTACT PHONE; � � ( CS-C)
<br /> : CONTACT EMAIL:-y1jesx - •V<1 J cl T1 t lel rt. i eo /
<br /> AGREEMENT:T hereby oertUy that I have reed and examined this application end know the same to be true and correct. All provisions of laws end ordinances go eralpg 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 yr cancel the provisions of any other state or
<br /> local law regulating conatnrotion or the performance of construction, That I am authorised by the owner of this property to perforin the work for which application Is made and l
<br /> comply with the State Contractors Law 79.27 RC W end 296.200 WAC,
<br /> City of Everett Official Use Only
<br /> FEE
<br /> 00
<br /> / / ; �/ /• PERMIT#
<br /> iv/ - \ct IILe EC1190 - 0 tr--7
<br /> Owner/AuthorIzed Agent Signature Date (Revised 70/72/2075)
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