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LECTRICA L PER v;`) T h L.0e*TON <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT,WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 I (E) everetteps@everettwa.gov I www.everettwa.gov/permits <br /> SITE <br /> ..;: <br /> PROJECT ADDRESS: " 1 S _I rt C <br /> BUILDING AREA(if residential, new construction, remodel,,or addition) SF <br /> BUILDING TYPE: 0 SFR-DETACHED 0 SFR-ATTACHED 0 DUPLEX 0 MULTI-FAMILY-#OF UNITS: COMMERCIAL <br /> USE OF BUILDING; Ch( <br /> EL ECTR CA,L. APPLIC LTION ] I FQRN11�'1'90Yi1 <br /> CONTRACT PRICE OF WORK:$- 13e ... <br /> NUMBER OF DEVICES (if low voltage): M <br /> FIRE ALARM? 0 YES NO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): /,, <br /> DESCRIPTION OF WORK: 5QL u '_, _tie ," oto---v p - ,hf S <br /> Ok%nd cQjrPnr) hot <� <br /> Lc ) z <br /> r•.- <br /> CO Iil(TAC`'1' 1 N FO RMAT 101J-� <br /> OWNER NAME: BIND - JV frLti,j_y . Sq/CallaANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET j`IL J <br /> CIT( STATE ZIP <br /> OWNER PHONE 2 �..5 '" / 2'10 0 ... .. ...OWNER EMAIL: .. ... ...._.._.. . .: . ,. .�.. _,. .. .-. ._....._............. _-,. ._.....,_ ..-_ <br /> CONTRACTOR NAME: n ' of Pas.l RC. <br /> CONTRACTOR ADDRESS: STREET I ,GLd'(Ltcc S <br /> f7��O ( '( G <br /> 7c 'cnrp2 v€r STATE C,()A ZP ` 26 <br /> CONTRACTOR PHON 42 O - 3 Kc J 5 COON]TRAACTOR EMAIL: bur5On;-1- o!faa C.r Cd al <br /> CONTRACTOR LIC.#(REQUIRED) /� rJQ -!`-��1 7 / mw NCITY OF EVERETT BUSINESS LIC.#(REQUIRED):Y ^N V <br /> PRIMARY CONTACT: 0 OWNER i'1 CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: C.FZ 1S,. 7/ 1 prj <br /> ( /1� <br /> CONTACT EMAIL; (1-� 5On)+rO' -'I"1 C: (,6(1AGREEMENT.'T hereby certify that I have read and examined this application and know the same to be true and correct,All provisions of! 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 lawregulafing 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 295.200 WAC. <br /> City of Everett Official Use Only <br /> FEE <br /> • PERMIT <br /> � #/ <br /> OwnerlAuttioriZed Agent- gnature ate (Revised 10/1212015) <br />