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03/03/2016 THU 12: 16 FAx 4252521666 CM Heating U003/004 '4L ELECTRICAL PERMIT AILICATION CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET, EVERETT, WA 98201 (P)425-257-8810 I FAX 425-257-8857 I (E) everetteps@everettwa,gov ( www,everettwa.gov/permIts ;PROJECT°.SIT[', INFORMATION •,• ;' . PROJECT ADDRESS: s).„0 0 OWC,i ( o Q S I BUILDING AREA(If residential, new construction, remodel, or addition), SF BUILDING TYPE: ❑ SFR-DETACHEFR-ATTACHED ❑ DUPLEX ❑ MULTI-FAMILY-#OF UNITS: ❑ COMMERCIAL USE OF BUILDING: • —� ELECTRICAL.,APPLICATION,INFOliMA`><'ION CONTRACT PRICE OF WORK: $ • aC'� NUMBER OF DEVICES (If low voltage): FIRE ALARM? ❑YES CJ NO ASSOCIATED BUILDING PERMIT# (If applicable): DESCRIPTION OF WORK: cicikcA,uze 4, haw hose- pu-rio • CONTACT INFORMATION OWNER NAME: \,\A‘'E 0.10 TENANT NAME(If CommercIal): OWNER MAILING ADDRESS , STREET j�?It) w ©fziz, CITY STATE (A) ZIP c1g Q OWNER PHONE: 105 oC `'I O5 O OWNER EMAIL: CONTRACTOR NAME: C Y I CONTRACTOR ADDRESS: STREET 1U 15 aRoacb_)}�f' CIN e, eKe STATE V ZIP c' a`^' I.V 1 CONTRACTOR PHONE:H alOO( OHO CONTRACTOR EMAIL: Ml°XZedlM C h- fin q , Corfl CONTRACTOR LIC.#(REQUIRED): CArYthertiMil `1?GIN CITY OF EVERETT BUSINESS LIC.#(REQUIRED): IGO% - - 1 PRIMARY CONTACT: ❑ OWNER gCONTRACTOR 0 OTHER(Please Spoclfy) CONTACT NAME: CONTACT PHONE! 142 1 ( sd / d_ iC. !ep�► Vl- CONTACT EMAIL; C' 0_7 CC()kl.-a , rg, on AGREEMENT:T hereby certify that/have read and examined this application and know the seine to be true and correct, A/f provisions of laws sod ordinances governing Ihts typo of work will be completed whether specified herein or not. The granting of e permit does not presume to give authority to violate or cancel the provisions of any other state or local law regulating consiruotlon 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 1 comply with the State Contractors Law 113-27 ROW and 288.200 WAC. City of Everett Official Use Only FEE PERMIT &A../ 1./, Ae/6_/;At :51) E 1L002) .- Owner/Authorized Agent Signature Date (Revised 10/12/2015) SS-52- V e P Pk) o