4101 COLBY AVE COE SIGNAL SERVICE ADDRESS 2017-06-12

-7 'LECTRICAL PERMIT ".�'UCATION �d CITY OF EVERETT PERMIT Si' kVICES 3200 CEDAR STREET, EVERETT, WA 98201 (P)425-257-8810 FAX 425-257-8857 ] (E) everetteps@everettwa.gov ] www.everettwa.govipermits �ROJE -T SITE INFOIRIVIATI61 PROJECT ADDRESS: LaCot e 1 .- vI Ce &-Jrfsj BUILDING AREA(if residential, new constr ction,remodel, or addition) SF BUILDING TYPE: ❑SFR-DETACHED ❑SFR-ATTACHED ❑ DUPLEX ❑MULTI-FAMILY-#OF UNITS: ❑ COMMERCIAL USE OF BUILDING: -1 ELECTRICAL APPLICATIOM INFORMATROP➢ CONTRACT PRICE OF WORK:$ )UI A FC e NUMBER OF DEVICES (if low voltage): FIRE ALARM? ❑YES ❑NO ASSOCIATED BUILDING PERMIT#(if applicable): rrrr ; DESCRIPTION OF WORK: ra*,,`,..4 elI l ju, 4ixF6 I j i1 �f1h . CONTACT INFO111MATIOf I OWNER NAME: pf TENANT NAME(If Commercial): NIA OWNER MAILING ADDR SS: STREET MY S I ATE ZIP OWNER PHONE: OWNER EMAIL: CONTRACTOR NAME: E160A of CONTRACTOR ADDRESS: STREET I 75 S'f S W CIN V(re f STATE w/T ZIP 9,20 CONTRACTOR PHONE: '/-2S-7Y5- 500 CONTRACTOR EMAIL: CONTRACTOR LIC.#(REQUIRED): !jb 0 CITY OF EVERETT BUSINESS LIC.#(REQUIRED): PRIMARY CONTACT: )KOWNER ❑CONTRACTOR ❑OTHER(Please Specify) CONTACT NAME: I CONTACT PHONE: y�Z f o2S'7 r 7o2d Fu#7(-k � CONTACT EMAIL: e0 C("5 e�� uq. Ia AGREEMENT.-T hereby certify that l have read and examined this application and know the same to be true and correct. All provisions of laws and ordinances governing this 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 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 l comply with the State Contractors Law 18.27 RCW and 296.200 WAC. City of Everett Official Use Only FEE jI =�l PERMIT# 6414� 4ij I Owner/Authorized Agent Signature Date (Revised 10/12/2015)