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7 ECTR1C 4,L PERMIT A 'LICATIO <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 1 (E) everetteps@everettwa.gov 1 www.everettwa.gov/permits <br /> . PROJECT SI'f E INFORMATION <br /> PROJECT ADDRESS: ).32aJJ F-0.4" :,.\\ "A,A, I t•/ �`i ft--( ric relit??� lam? P' <br /> BUILDING AREA(if residential, new construction, remodel, or addition) RCit'ir‘O K ej SF <br /> BUILDING TYPE: ❑ SFR-DETACHED ❑ SFR-ATTACHED 0 DUPLEX 0 MULTI-FAMILY-#OF UNITS: /t1... <br /> NITS: ,COMMERCIAL <br /> USE OF BUILDING: /UNI y��.� CO�)'1��9f1 .. _.. _. __. _..._. -.- <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK: $ /00i 000 , CI`) . <br /> NUMBER OF DEVICES (if low voltage): '7 12- <br /> FIRE ALARM? 0 YES lkNO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIPTION(� OF WORK: j2iJ�1,llj} 1/ CA- (1i t3Ie- ,�n , -C-bur `F/ <br /> - jr(.�U <br /> -Cot- co o'1 DtJ`t fir'4- P I"1 G0�1 i. 1 C.CJ i ri ie.�i I 0 KZ _ <br /> 4+U t r I.��°i \ be- + 4- 2i& C(00r <br /> �� II b e „ci .1-h ('r <br /> ��� � vel � �- � � <br /> CONTACT INFORMATION <br /> OWNER NAME: 1 \CIA',.k.90 u; &LA'G(i4 tV��4'kANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET &,1 Uvl� e,,I, . 417)tJ -C <br /> CITYSTATESTATE / ZIP J I <br /> OWNER PHONE: vt)i5 bC1 _3 SOO OWNER EMAIL: M�I'l c/�L°i ? s (--J(-6 S/Decji.11 .� Li( .� <br /> CONTRACTOR NAME: 11A.t. -)1 C D#YI rvluyr) e L '�(QN f f` <br /> CONTRACTOR ADDRESS: STREET 600.7 )-1.441 LAvt /U <br /> CITY ;&ATt G^i STATE ki ZIP q(J1 /S- <br /> CONTRACTOR EMAIL: S- VI ertc C j/--)674 0- `41�i/ n <br /> CONTRACTOR PHONE: �� �,5� '" � � 2_2_ � �1 (,� � Lv 11,1 <br /> CONTRACTOR L1C.#(REQUIRED): 1/`-117:--t2- G(,,--• Q1 Ll i C.>} - CITY OF EVERETT BUSINESS LIC.#(REQUIRED): C.. (9)t O <br /> PRIMARY CONTACT: �-OWNER 0 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: 2_06 145 - S� Z Z <br /> �r11UVlc') jLf(Y\ CONTACT EMAIL: 4 here � (i t'"1 69 c ifhCI, iI ,. (-OA <br /> a`. <br /> AGREEMENT. T hereby certify that I have read and examined this application and know the same to be!rue and areAll provisions of laws arfo 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 I <br /> comply with the State Contractors Law 18.27 RCW and 296.200 WAC. <br /> City of Everett Official Use Only <br /> FEE al <br /> PERMIT# <br /> Owner/Auttio zed Agen gnature Date (Revised 10/12/2015) <br />