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ECTRIICAL PERMIT 4—_11CATION <br /> f 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.govipermits <br /> PROJECT ADDRESS: 11 ti b SekH(�g57— <br /> BUILDING <br /> z$TBUILDING AREA(if residential,new construction,remodel, or addition) SF <br /> BUILDING TYPE: iPISFR-DETACHED 0 SFR ATTACHED 0 DUPLEX 0 MULTi-FAMILY-#OF UNITS: 0 COMMERCIAL <br /> USE OF BUILDING: • <br /> • :: •EL1 C`l°RICA) TIVIAC C TlIi ICM IINIFO MATZO r <br /> CONTRACT PRiCE OF WORK:$ 3-7r `l <br /> NUMBER OF DEVICES(if low voltage): <br /> FIRE ALARM? 0 YES ,N NO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIPTION OF WORK: <br /> ADP Z TGE — gt <br /> :dONTACT.iNIFORNIATION _ <br /> OWNER NAME: /j9-/-7 S 1/Ot-(j ` TENANT NAME- - (If Commercial): <br /> OWNER MAILING ADDRESS: sTeeEr �y�^/D/L3 6�Q� 5e4G(fS ! 44,76 J� 9 /) <br /> CITY /A✓/ /' STATE 144— ZIP /V �[G.—3 <br /> �y 2�-7 � <br /> OWNER PHONE: d05 V77-37 <br /> t 7-37 3 �. w OWNER EMAIL: �/ <br /> CONTRACTOR NAME: VAI . 2&,F-6111—.--1g ( /////VC- <br /> CONTRACTOR ADDRESS: STREET 42 I f ,/1f,Q7– <br /> S� <br /> cr ' STATE it../A- ZIPR Z�O3 <br /> CONTRACTOR PHONE: 3. 0 n�� 5/0 cCONTRACTOR EMAiL: V4PLL66TP-JC ') Yfr '� • C <br /> O <br /> CONTRACTOR LIC.#REQUIRED):V�f ` gCITY OF EVERETT BUSINESS LIC.#(REQUIRED): 05- 3S—/‘ <br /> PRIMARY CONTACT: XOWNER u. 0 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: 6s— q 7` 3 7 3'J <br /> ?°rft l $T i.D 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 properly to perform the work for which application is made and i <br /> comply with the State Contractors Law 18.27 RCW and 296.20;9 WAC. <br /> City of Everett Official Use Only <br /> FEE <br /> sdf <br /> PERMIT# <br /> 4 /24 E 1 t a - 15( <br /> Owner/Authorize Agent Signature Date (Revised 10/92/2015) <br />