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SIP.mr ALL CTRICAL PERMIT [1 PLICATII0N , <br /> '',:,-.''Ivi::=1,,,v,2fr• CITY OF EVERETT PERMIT SERVICES <br /> �_ rtrT <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 1 (E) everetteps@everettwagov J www.everettwa_govlpermits <br /> .. ; " <br /> .:. ... .: . . <br /> `,.PR4 JECT,SITEINFONWATIIQN,; •', <br /> PROJECT ADDRESS: t2-2., 5 1...9, CSS S' Sd E-5 Eve--Cb-" - 9%3'2 0 `3 <br /> BUILDING AREA(if residential, new construction,remodel,or addition) SF <br /> BUILDING TYPE: ❑SFR-DETACHED ❑SFR ATTACHED El DUPLEX 54-,MULTI-FAMILY-#OF UNITS: El COMMERCIAL <br /> USE OF BUILDING: AAcS'f' {-c-.--i( .) <br /> . pp Ili <br /> �n 7�ppqq pp��q <br /> " YYIB�A _ . <br /> p� fir. �'R® . .. <br /> f�Rl .�a _ .. <br /> CONTRACT PRICE OF WORK:$ ~'l 17 da • <br /> NUMBER OF DEVICES (if low voltage); • <br /> FIRE ALARM? ❑YES D NO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIPTION OF WORK: Tv\S"NJ 6 v c-1' c t3 ``v..3 1'51-0`‘S--t-oc- 2-.4-,- 1(J <br /> 1 <br /> C)I1/NER NAME= t t cc ta3,Axa U-dTENANT NAME(if Commercial): <br /> OWNER MAILING ADDRESS: STREET <br /> CITY STATE ZIP <br /> OWNER PHONE: ,_OWNER EMAIL:,., .., ..._,.,. v.... ., .... .. .. ., v.�R <br /> CONTRACTOR NAME: �� 5 y... Tri, Vow- ' E r c - <br /> CONTRACTOR ADDRESS: STREET 2-236 A dc- '`5 A -cl <br /> CITY Sv'---F'Q- STATE Us-,C\ (� q ZIP -1�/z-0 3 <br /> CONTRACTOR PHONE: tk zs--Zia -- 7(3.3C CONTRACTOR EMAIL: ' fc wA etc-*. OW e---C-'2 eC.. C wt <br /> CONTRACTOR LIC #(REQUIRED) CITY OF EVERETT BUSINESS LIC.#(REQUIRED);O�IP <br /> ub <br /> , s <br /> PRIMARY CONTACT: EI OWNER El CONTRACTOR El OTHER(Please Specify) <br /> CONTACT NAME: `` CONTACT PHONE: ZoG ^- S' ..5----‘-( E ` <br /> 'T8 6-1- \ . 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 orthe performance of construction. That t 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 /> - n <br /> FEE <br /> • <br /> 4 15,09 <br /> 1 <br /> 1 PERMIT# <br /> .` 2--&-S1-9— . —( (--/ 6 , E k ,p O� — d 1p <br /> Ovvner/Authorized Agent Signature Date . (Revised 10/12/2015) <br />