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A � ELECT) WAIL PERMIT / UUCATIION
<br /> / CITY OF EVERETT PERMIT J AVICES •
<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 /> F.;._,,:-:::.:, :,.:..2.,.,,.::::,: , _..:, : „: :::: .::: ,.:..:.._: . :: P014p-J40-r-:piTE...114F-cillompoirA. .::.,, ,=,:,,,, -, ...;,,...,:..:::.: ::: :::. , . .-; :...:.:,...,,,-,__... ,,-;,
<br /> PROJECT ADDRESS: 9-Q 05` /6 -"l 6-h fr.
<br /> BUILDING AREA(if residential, new construction,remodel,or addition) rkO SF
<br /> BUILDING TYPE: 0 SFR-DETACHED PCSFR ATTACHED 0 DUPLEX 0 MULTI--FAMILY-#OF UNITS: El COMMERCIAL
<br /> USE OF BUILDING: 5,„) (Q J . 141.1
<br /> ELECTaRptAI APPS cATIalit I FORnnATa®N
<br /> CONTRACT PRICE OF WORK:$ //(fie
<br /> NUMBER OF DEVICES (if low voltage): 2
<br /> FIRE ALARM? 0 YES WNO
<br /> ASSOCIATED BUILDING PERMIT#(if applicable): / l4'
<br /> DESCRIPTION OF WORK: eGQi ftj ' ( 41-41,-1)-e Pe, el 91f05/C0 tg,j'
<br /> CONTACT:INFORMATION
<br /> OWNER NAME: VI cine \, e,(C'c(l oin . TENANT/ ?NAME(If Commercial):
<br /> OWNER MAILING ADDRESS: STREEJ r9096 F O 72u1 ", gt "�
<br /> CRY �Q ie/i STATE `'b� ZIP . fj' ,-)(
<br /> OWNER PHONE: . OO(/ ,.IO Q J. . s t! .. OWNER EMAIL:,.. .100,46 fian el ythDo. CbfY)__..._. _... .�......_�._._
<br /> CONTRACTOR NAME: C1474/'l'1 D4 i S" C/i(/till._ /1(
<br /> CONTRACTOR ADDRESS: STREET /33 (9 t 07 F 52
<br /> • CITY 717///6t,el/ STATE jz � / ZIP ,°f10lU
<br /> CONTRACTOR PHONE: 111 G
<br /> J - �(�'l/`"i I,' CONTRACTOR EMAIL: 64/A, '3 C� ' ,4/b (49/
<br /> q
<br /> CONTRACTOR LIC.#(REQUIRED): L / P De 0GG CITY OF EVERETT BUSINESS LIC.#(REQUIRED):0S5 / (�
<br /> PRIMARY CONTACT: ❑ OWNER -CONTRACTOR 0 OTHER(Please Specify)
<br /> CONTACT NAME: CONTACT PHONE: 4/ 5 /��� //
<br /> _l)6,7 G
<br /> ,N214,-, 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 or the performance of construction_ That/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 98.27 RCW and 296.200 WAC.
<br /> City of Everett Official Use Only
<br /> FEE
<br /> Ai \ DD.6,
<br /> i ,
<br /> F MIT#Arilp NO—
<br /> .../.5/.. / • /
<br /> Owner/Auth• :A•ent Signatur Date (Revised 10/12/2015)
<br />
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