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"ow <br /> ILEO ICAL PERMIT APPLICATION <br /> 011, <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 INFCRNIA77®lel <br /> PROJECT ADDRESS: 1-4 I (4> ,uc Cr ke-e /4,.s (_ <br /> BUILDING AREA(if residential,new constructio ,remodel,or addition) SF • <br /> BUILDING TYPE: SFR-DETACHED FR-ATTACHED 0 DUPLEX 0 MULTI-FAMILY-#OF UNITS: 0 COMMERCIAL <br /> USE OF BUILDING: 5 Fg <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK:$ 5 0= <br /> NUMBER OF DEVICES(if low voltage): <br /> FIRE ALARM? 0 YES C90 <br /> ASSOCIATED BUILDING PERMIT#(if applicable): �" <br /> DESCRIPTION OF WORK: /Pot 01 Q c. f. J e-± til} (U of v_g0,-)-) <br /> CONTACT INFORMATION <br /> OWNER NAME: rel tGke /639/0/ TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET r l(6 ,CV )C lcs4 0 e <br /> CITY EL ��..e. ll STATE `'"4 ZIP?g 26 /_ <br /> OWNER PHONE: A S----3 c ©3 D'`E OWNER EMAIL: <br /> CONTRACTOR NAME: K)C.Lpe__ 1 f T 'fir csj_e c.. <br /> CONTRACTOR ADDRESS: STREET 1(:3(Lc [ �61,-,e.56- <br /> CIT / c� ,ems <br /> Y a- e& STATE 14. ZIP 99�88 <br /> CONTRACTOR PHONE:LAO�,i i9 or-((8'5 CONTRACTOR EMAIL:ACP _./Cc lef1 7 f. <c/` i <br /> CONTRACTOR LIC.#(REQUIRED): j 4,, E.T (`'t� CITY OF EVERETT BUSINESS LIC.#REQUIREb C <br /> PRIMARY CONTACT: VOWNER 0 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME:---- <br /> AME:®� CONTACT PHONE: GFR.5--3'Q_((8 <br /> 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 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 /> 7L <br /> PERMIT# <br /> a—r2X ,--1 CQ° l P E 1 g0 , ( 5$ <br /> r/Authorized Agent Signat Date (Revised 10/12/2015) <br />