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!LECTRCAL PERMIT A-PLICATION <br /> ' rr <br /> �. CiTY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> (P)425-257-8810 J FAX 425-257-8857 I (E) everetteps©everettwa.gov 1 www.everettwa.govlpermits <br /> : PR EJECT SITE IINF 0 Rllifpa®94f :.: <br /> PROJECT ADDRESS: G3\QI Soo v)A LWC ��r.9 CII(Z2-0; <br /> BUILDING AREA(if residential,new construction,remodel, or addition) SF <br /> BUILDING TYPE: 0 SFR-DETACHED 0 SFR ATTACHED 0 DUPLEX 0 MULTI-FAMILY-#OF UNITS: ❑COMMERCIAL <br /> 'USE OF BUILDING:\d\ <br /> l LgcTR CAL APPlacAT>iO 1 IN>FORMAT ON '.: .: <br /> CONTRACT PRiCE OF WORK:$ t , (�j �- <br /> NUMBER OF DEVICES(if low voltage): <br /> FIRE ALARM? El YES A NO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIPTION OF WORK: <br /> - I,,,,, h pmol- - <br /> • <br /> ONTA TIie1F.-:R.._ Tititi. . ._.. • .. <br /> OWNER NAME: "ftl.e 00\rt i TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET <br /> c� / q? CITY STATE ZIP <br /> OWNER PHONE:(/ 6.3.) 3*--ggOtiG OWNER EMAIL: <br /> CONTRACTOR NAME: k, New 1\03 %v\ <br /> CONTRACTOR ADDRESS: STREET J i S(4 OS M .. 5—F )D3 <br /> CITY 1j4 \ /STAVE W� IP ("MCA/L.("MCA/L.CONTRACTOR PHONE: ," i '$ LIS5- 333 CONTRACTOR EMAIL: Jc(NM‘At)+.3 Go ►vl a COWL <br /> CONTRACTOR LIC.#(REQUIRED): "N‘1\1 A Q '7 I<2 CiTY OF EVERETT BUSINESS LIC.#(REQUiR ): S ..19-,S <br /> PRIMARY CONTACT: 0 OWNER CONTRACTOR 0 OTHER(Please(1.2 .) <br /> SpSpecify) (61&j -' rz- -709 <br /> CONTACT NAME: CONTACT PHONE: .�_"'1QG( . <br /> 1-GJO'� CONTACT EMAIL: 70) 41w ‘,-t'Ga <br /> AGREEMENT.-T hereby certify that I have read and examined this application and know the same to be rue 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! <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 /> . i co „.....„....-.--_ 1 <br /> PERMIT# <br /> 2/i fJ kq- 12- � 7 <br /> 7 <br /> Owner/Au ized Agent Signature Dat (Revised 10/12/2015) <br />