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-LEC RIC AL PERMIT P , �DLICATQON <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 J (E)everetteps@everettwa.gov www.everettwa.gov/permits <br /> PROJECTSITE INFORMATIONPROJECT ADDRESS: SE vere�H' Ma I I LJ, 'A i <br /> ti <br /> BUILDING AREA(if residential, new construction, remodel, or addition) a SF <br /> BUILDING TYPE: ❑ SFR-DETACHED ❑SFR-ATTACHED ❑ DUPLEX ❑ MULTI-FAMILY-#OF UNITS: 1!1 COMMERCIAL <br /> USE OF BUILDING: C'_0 0 h'li/AIC I LC l <br /> [ELECTRICAL APFUCCA'TION RMFORMATION <br /> CONTRACT PRICE OF WORK: $ &L% <br /> NUMBER OF DEVICES(if low voltage): <br /> FIRE ALARM? [A.YES ❑NO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIPTION OF WORK: <br /> nS+AL-&' 'WCk t ISS ICL <br /> CONTACT,INFORMATION <br /> OWNER NAME: Qe)b i a, C1') TENANT NAME(If Commercial): Bobav--heL To S <br /> OWNER MAILING ADDRESS: STREET !✓ -Vexe- 1 G�II a # <br /> CITY ��Y� STATE w zIP C_ <br /> OWNER PHONE: -r- OWNER EMAIL: <br /> CONTRACTOR NAME: 1 () Shy Q I C4e�,S <br /> CONTRACTOR ADDRESS: STREET 1(0 <br /> CITY M10 STATE zip C� I <br /> CONTRACTOR PHONE: ,-?.r,X30 .8 1(00 ICONTRACTOR EMAIL: bb-(-S 12 r13 Vn S n . CO M <br /> CONTRACTOR LIC.#(REQUIRED): Sl ;# 9®'PQ g -3,9 -I i? I CITY OF EVERETT BUSINESS LIC.#(REQUIRED): ("}rJ" -c <br /> PRIMARY CONTACT: ❑ OWNER XCONTRACTOR ❑ OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: ,,L/2j . 33v . 6 J(00 <br /> T 'u ' CONTACT EMAIL: b&K5ccy�' fyl,5 n, C Um <br /> AGREEMENT.•Thereby 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 I am authorized by the owner of this property to perform the work for which application is made and/ <br /> comply with the State Contractors Law 18.27 RCW and 296.200 WAC. <br /> City of Everett Official Use Only <br /> FEE <br /> ov <br /> PERMITI#n I <br /> 0 <br /> wne Autlio "zed Agent igna Date (Revised 10/1212015) <br />