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,--„,-'- 47,.. ACTRICAL PERMIT APICATION <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 /> L ,r EC` PROJSI <br /> IT NF© tMATIOI <br /> PROJECT ADDRESS:(Q Lt� t c/(,0.4 i— L-os <br /> BUILDING AREA(if residential,new construction,remodel,or addition) V\ ( C4 SF <br /> BUILDING TYPE: 0 SFR-DETACHED 0 SFR-ATTACHED 0 DUPLEX eMULTI-FAMILY-#OF UNITS:`to 6 0 COMMERCIAL <br /> USE OF BUILDING: <br /> ELECTRICAL AP,PU,CATION INFORMATION ., <br /> CONTRACT PRICE OF WORK:IR z (at O <br /> NUMBER OF DEVICES (if low voltage): <br /> FIRE ALARM? 0 YES I NO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIPTION OF WORK: '2.--s- a,yA,1p ,1��;�,4AQ( c,I <br /> C{CIL.yYLL.4'L <br /> '' ,. Iti*OTAC T)7NFOR ATIONa <br /> OWNER NAME: IAJI I kat/Lets, I V V` i-nAe.'4 TENANT NAME(If Commercial): ✓n 61 <br /> OWNER MAILING ADDRESS: STREET 10(r!�/ CAS(wb �i 6. (_ /��1 �)y�� <br /> CITY �/�C/l/ -�•d STATE kJ \ ZIP Cl �J`� l <br /> OWNER PHONE: '71 V1 i 31 OWNER EMAIL:i/i/�'foe 6t(du/Rot„ J2,. <br /> CONTRACTOR NAME: (j` Vl,L. , AA.... v� �/I-- <br /> CONTRACTOR ADDRESS: STREET?!I t t4, 2 !- Q l (S W -- ( + �} ]`� <br /> „ <br /> CITY \N 1 (.........*-1---- STATE 1 ,J/ ` ZIP 7 v 3 <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: VVV --_ � <br /> CONTRACTOR LIC.#(REQUIRED): �-�Sk? �J�j CITY OF EVERETT BUSINESS LIC.#(REQUIRED):C - t {q <br /> 0 <br /> PRIMARY CONTACT: 0 OWNER CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: f, /.�-(7. {- 1,6y <br /> l'r/t,Q(ti Li" Ctirvi, CONTACT EMAIL: iYti f Il l lilt L%u1�1"e m <br /> AGREEMENT'T hereby certify that/h e ad 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 sp coed 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 lam 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 /> (6,o.qv <br /> 110 / / PERMIT# <br /> c3/ r�l/� E e-7o3 . (c.3 <br /> Owner/Authoriz i Agent Signature 4 Date (Revised 10/12/2015) <br />