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4111,_., . <br /> •ECT IC.,.: L PERMIT / , LICATION <br /> CITY OF EVERETT PERMIT - ICES <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: 2. 2t 1......0.4-1-7-1-4 --5 -"y- , <br /> BUILDING AREA(if residential,new construction,remodel,or addition) ps. SF <br /> BUILDING TYPE: 0 SFR-DETACHED 0 SFR-ATTACHED 0 DUPLEX 0 MULTI-FAMILY-#OF UNITS: COMMERCIAL <br /> 'T <br /> USE OF BUILDING: � A P NI --) ,,``�� <br /> .. ... . .... <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK:$ 3 ) <br /> NUMBER OF DEVICES (if low voltage): <br /> FIRE ALARM? 0 YES L' 10 <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIPTION OF WORK: - , 'a' --t-ot_, ..- t t .,�O 1..'r- 6 /../ c._-. - <br /> i NJt . 1r a.. .1 `7-12.-,4 Nis F5 g. 1- ' ' ii 'U'°��` T <br /> gZ ' - A . <br /> CONTACT.INFORMATION <br /> • <br /> OWNER NAME: Ac) s?_P .,c-1 0' TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET '7;70 I I /�cia �OcP 1`4' ''j y `� L-4...) <br /> " ! �� <br /> CITY 4� STATE 4'7j('�}�✓A ZIP k--) <br /> OWNER PHONE:42.'b"3) 2 l� OWNER EMAIL: <br /> CONTRACTOR NAME: l c % ,3 . .. t ci LC;A(.... <br /> CONTRACTOR ADDRESS: STREET Pia . y 7 <br /> CITY .'� /L STATE1-.)---44- ZIP <br /> CONTRACTOR PHONE: . 32c-za59 / CONTRACTOR EMAIL: <br /> CONTRACTOR LIC.#REQUIRED. _ `� ,, P - CITY OF EVERETT BUSINESS LIC.#(REQUIRED):C) 1 <br /> PRIMARY CONTACT: 0 OWNER L ONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: t4 2 ----18-9 -"'7 <br /> 12-A I( =.2.Fi 6-S i h 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 /> PERMIT# <br /> Owner/Authorized Agent Signature Date (Revised 10/12/2015) <br />