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LECT IC,-\L PE MIT QCAT •N <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 /> PROJECT SITE INFORMATION <br /> PROJECT ADDRESS: 4 5300 LA) G"1� 77 /v/.4LL /4/, J` �/� 1 i/4• �8 <br /> BUILDING AREA(if residential, new construction, remodel, or addition) SF <br /> BUILDING TYPE: ❑SFR-DETACHED ❑ SFR-ATTACHED ❑ DUPLEX ❑ MULTI-FAMILY-#OF UNITS: `Cl COMMERCIAL <br /> USE OF BUILDING: =1/JT.(J/ ' 4 t.,17�1' //n eC,r <br /> E ECTRICA APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK: $ 4,(7a2. - <br /> NUMBER <br /> , 'NUMBER OF DEVICES(if low volta•-): <br /> FIRE ALARM? ❑YES to-tcro <br /> ASSOCIATED BUILDING PERMIT#(i able): <br /> DESCRIPTION OF WORK: <br /> L- L-/&- 77�G17cf't i <br /> CONTACT INFORMATION �j► <br /> OWNER NAME: S-/ <br /> .� TENANT1�'NNAME(If Commercial): f,&( / <br /> -- <br /> . T7•' t` r�` 1'� <br /> OWNER MAILING ADDRESS: STREET � /C 11/ !� �/TG� I/1/ y / <br /> CITY �-�' 7� STATE /4/7/ ZIP 94e /�]el <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: ,-/ <br /> CONTRACTOR ADDRESS: STREET // V S�~�0r 3 3 P�-�P ' /� <br /> CITY ` �Z/4,4.5- <br /> W1A/Ok p STATE ZIP 17 <br /> CONTRACTOR PHONE: c/aala 3 3 s `, CONTRACTOR EMAIL: C er 41L j . L�' <br /> CONTRACTOR LIC.#(REQUIRED): ( /t- LAG f '�`Lg( CITY OF EVERETT BUSINESS LIC.#(REQUIRED): ,51—S-47/6 <br /> PRIMARY CONTACT: ❑OWNER r,leONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: <br /> &El 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 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 <br /> 0 <br /> PERMIT# <br /> �' f�� //„.,2 E � ��-�9 - io( <br /> Owner/Autho d Ag t Signature Date (Revised 10/12/2015) <br />