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07/22/2016 FRI 13: 26 FAX 425 252 1666 CM Heating Q003/014
<br /> v„,„‘„,/#1,414vHIP:L.--; ELECTRICAL PERMIT AP -LICATION
<br /> CITY OF EVERETT PERMIT SERVICES
<br /> 3200 CEDAR STREET, EVERETT, WA 98201
<br /> (P)425-257-8610 I FAX 425-257-8857 I (E)everetteps cDeverettwa,gov I www,$verettwa.gov/permits
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<br /> PROJECT ADDRESSr �) Q �' A � — C4._U \ L S e,
<br /> BUILDING AREA(If residential,new construction, remodel,or addition) SF
<br /> BUILDING TYPE: 0 SFR-DETACHED Ca SFR-ATTACHED 121 DUPLEX 0 MULTI-FAMILY_ -#OF UNITS: XCOMMERCIAL
<br /> USE OF BUILDING:
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<br /> CONTRACT PRICE OF WORK: $ lop . s�
<br /> NUMBER OF DEVICES (If low voltago):
<br /> FIRE ALARM? Cl YES 0 NO
<br /> ASSOCIATED BUILDING PERMIT#SIf,pplleable):
<br /> DESCRIPTION OF WORK: • ^
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<br /> OWNER NAME: 'I \. { \.QQOC TENANT NAME(If Commercial);torn(v14-13425
<br /> OWNER MAILING
<br /> GfY ok A 'STATE ztPq 530
<br /> OWNER PHONE: . 0% irrr�, OWNER EMAIL:
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<br /> CONTRACTOR NAME: .�� I\ titan
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<br /> CONTRACTOR ADDRESS: STREET gj.A
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<br /> cm' , i 7 _ STAR
<br /> CONTRACTOR PHONE: • O' 5t, CONTRACTOR EMAIL;Y1t2 T)i" t (ab
<br /> CONTRACTOR LIC.#REQUIRED I .11 IA a - V1, di, CITY OP EVERETT SV$INESe LIG.#REQUIRED: /0 9j
<br /> PRIMARY CONTACT: C] OWNER I CONTRACTOR CI OTHER(Please Specify)
<br /> CONTACT NAME: CONTACT PHONE: OP e:imi• -t
<br /> CONTACT EMAIL: I, i9• e.)14 ,�•m
<br /> AGREEMENT::T hereby oe'lfy that I have read and examined this application and know the same to be true and correct. All provisions of laws and and noes governing this
<br /> We of work will be Completed whether Specified herein or not, The granting of a pQrmll does not presume to give authority to violate or cancel the provisions of any other state or
<br /> local leW r'epfrlaling construction or the performance of construction. That I em authorized by the owner of this property to perform the Work for which Application is made end I
<br /> comply with the State Contractors Law 18.27 ROW and 286.200 WAC,
<br /> City of Everett Official Use Only
<br /> FEE
<br /> 50,c12/
<br /> PERMIT#
<br /> • 1 /..• 1a -- 112 E ` 1—FO
<br /> Owner/Authorized Agent Signature Date (Revised 10/1712015)
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