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IEECTRJ1CAL PE QT APPLICATION <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 l www.everettwa.govlpermits <br /> PROJECT ADDRESS: /``Z Z. vmAES Ake. - <br /> BUILDING AREA(if residential,new construction, remodel,or addition) e*+J `- 5- SF 709 Sly <br /> BUILDING TYPE: Nr—SFR—DETACHED 0 SFR-ATTACHED 0 DUPLEX 0 MULTI-FAMILY-#OF UNITS: 0 COMMERCIAL <br /> USE OF BUILDING: 5'/X91() <br /> • ELECTRICAL INFORMATION <br /> CONTRACT PRICE OF WORK:$ e 00 <br /> NUMBER OF DEVICES(if low voltage): <br /> FIRE ALARM? 0 YES J10 <br /> ASSOCIATED BUILDING PERMIT#Of applicable): N/4- <br /> DESCRIPTION <br /> /4DESCRIPTION OF WORK: <br /> ,016 9-60-411 iP off A1C /7 v ` <br /> 23 C -6O 6 <br /> ' :- - CONTACT:INFORMATION. ._, <br /> OWNER NAME: SC'-#EM/3 TENANT NAME(If Commercial): Ai/4- <br /> OWNER <br /> OWNER MAILIINNGADDRESS: STREET NO O'�k , <br /> xtAr <br /> yl--•V ClCi=!/ cm' bu / STATE 9.5-3:Y/ ZIP <br /> OWNER PHONE: rZ5-`2-6 Sr"X7&13' OWNER EMAIL: -IN Uae_NU`/5 6 FiMhEf <br /> CONTRACTOR NAME: <br /> CONTRACTOR ADDRESS: smEEr /41?-6051 k • `' �/g �yy <br /> CITY � �- -1/ STATE YV i ZIP / eia/ <br /> CONTRACTOR PHONE: VZS Z6 7703 CONTRACTOR EMAIL: Litt d1/fl`t'6 U )Q&Y�`1&IPV <br /> ' G1 <br /> CONTRACTOR LIC.#(REQUIRED): M2,5t y I/ /7 CITY OF EVERETT BUSINESS LIC.#(REQUIRED): o.-501/603 <br /> PRIMARY CONTACT: 0 OWNER LPOZ NTRACTORYY"S�CI OTHER(Please Specify)._y`_zwns,.�...,.,.,.�....�.�Y....ar�.=..v_�>_.__Y.,....��..,,,..�Y..,.,,,.�.,.r...-.._,�, <br /> CONTACT NAME: CONTACT PHONE: 1/45- -76 7"760 <br /> `17 /r PY CONTACT EMAIL: LJJ iU)r5®Igoe,t 1E4-cal' <br /> AGREEMENT::T hereby certify that 1 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 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 296.200 WAC. <br /> City of Everett Official Use Only <br /> rFEE <br /> 1,0°°, <br /> PERMIT# <br /> 4i / f 2/4th 7 E 1l 12' 011 <br /> Owner/e- orized A'Sig nature Date (Revised 90/92/2095) <br />