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/4111/.1•%vz' <br /> ECTRICAL PERMIT AIkICATION <br /> CITY OF EVERETT PERMIT SERVICES <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 /> PROJECT SITE INFORMATION <br /> PROJECT ADDRESS: I 513 13 2'0 S 1' <br /> BUILDING AREA(if residential,new construction remodel r addition) C©C 0 SF <br /> BUILDING TYPE: 0 SFR-DETACHED 0 SFR-ATTACHED 0 DUPLEX 0 MULTI-FAMILY-#OF UNITS: ( 'COMMERCIAL <br /> USE OF BUILDING: <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK:$ 2 ,COO <br /> NUMBER OF DEVICES(if low voltage): <br /> FIRE ALARM? 0 YES lit NO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIPTION OF WORK: T I f-4) e.)&1,%) A-N./`ttlM & F I i N,i SS Gven, <br /> CONTACT INFORMATION <br /> OWNER NAME: ,/Lt.k- F l -o p<L'r 1 5' Q-J c -„-S TENANT NAME(If Commercial): dry`rl AA-6 -P ITA/a S S <br /> OWNER MAILING ADDRESS: STREET `>o b 1 17 <br /> Crit S MO Q U k(../v►I 0. STATE W A- ZIP `7 M C 5 <br /> OWNER PHONE: '1 ZS r '$g Z-913 OWNER EMAIL: <br /> CONTRACTOR NAME: tJ E W Li e g (. &-7n„i G (-L-<.- <br /> CONTRACTOR ADDRESS: STREET 64'' t yy�� -�- .. 572`3 9`17 5`- S AIS <br /> CITY E.V r -Z t Tr STATE VIA _ ZIP /BZDzr <br /> CONTRACTOR PHONE: 2-0C, 7 55' 360 b CONTRACTOR EMAIL: tO it L--1 Fe t.2C•rat c., LZ- C <br /> CONTRACTOR LIC.#(REQUIRED): J t✓W t..,(1-r✓ 489 Z 3 14 CITY OF EVERETT BUSINESS LIC.#(REQUIRED):(c d l LIS <br /> PRIMARY CONTACT: 0 OWNER Pi CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: tato '7 5 5 34&t , <br /> f <br /> /tum O Ni ®®(LIiCONTACT EMAIL: r✓ L.I (-0-e �c-mi.,cQ i-j e t/AA 1 L Cc)/h <br /> AGREEMENT T hereby certify that 1 have read and examined this application and know the same to be true and correct Ali 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 law regulating construction or the performance of construction. That tam 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 298.200 WAC. <br /> City of Everett Official Use Only <br /> FEE <br /> oi (,,/tel^ a; <br /> l PERMIT# <br /> y i EI 01- \ (q5 <br /> OwneLv) <br /> azed Agent Signature D e (Revised 1012/2015) <br />