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.ECT ICAL PERMITAP KATION
<br /> ON
<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 INFORMATION
<br /> PROJECT ADDRESS: 5r-7 VG 2 3.v D p c t V e u)
<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: `��� gyp
<br /> ELECTRICAL APPLICATION INFORMATION
<br /> CONTRACT PRICE OF WORK:$ 1 CQ 13 0 o
<br /> NUMBER OF DEVICES(if low voltage):
<br /> FIRE ALARM? 0 YES NO
<br /> ASSOCIATED BUILDING PERMIT#(if applicable):
<br /> DESCRIPTION OF WORK: L.—C i t2-1 C L.. 2 ' G L) LT"GZ et 1219 CA-0
<br /> CV CC\`Pk.. e
<br /> •
<br /> TA(01° ( c
<br /> CONTACT INFORMATION
<br /> OWNER NAME: %...)©2 V'* eivcc2- -ST1112MANT NAME(If Commercial):
<br /> OWNER MAILING ADDRESS: STREET
<br /> CITY STATE ZIP
<br /> OWNER PHONE: OWNER EMAIL:
<br /> ,,
<br /> CONTRACTOR NAME: �C—C 212��� t✓LAG 1 lz 1C� :.. ... ,.
<br /> CONTRACTOR ADDRESS: STREET 0 13®x. `7 7 i 2 ���((�� o r-�
<br /> CITY � � STATE pp wi-'�" ZIP (2 1 �'7
<br /> CONTRACTOR PHONE: A 2S S$ , to l0 2 CONTRACTOR EMAIL: I oC'fl€,,e, 1-)c-eve,freeleckrm.Q.
<br /> CONTRACTOR LIC.#(REQUIRED): 2I_� C--� PL CITY OF EVERETT BUSINESS LIC.#(REQUIRED)O41(./9`-l 2
<br /> .�.._.:,,.,:.u.r�..,...,:•.K.,...�,�:.,�,..,�.,:�u.,.�_::�,,:....,..,��..�.,......_,.-.m.,,.,,..�...�,..�v.�....:..,��:m..,........,_-.�,�...:.r.,:.::r_>:�_.r....-_..�..�..,.�...-.,,w.....a,w._:-_,,..,..:..::...�,,,,,,,,,,,,,��.w..._,,,.,.�.,__-�.._r_...,.M,:.,...,,w.:...
<br /> PRIMARY CONTACT: 0 OWNER .CONTRACTOR 0 OTHER(Please Specify)
<br /> CONTACT NAME: CONTACT PHONE: 425".`. 51©ca- S (0(0'2_
<br /> Lfl(-b` CONTACT EMAIL: jome.„ s" �2 c ..e i* e
<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 l am authorized by the owner of this property to perform the work for which application is made and 1
<br /> comply with the State Contractors Law 8.27 RCand 296.200 WAC.
<br /> FEE
<br /> City of Everett Official Use Only
<br /> � L---�
<br /> . Z06o499626 °tl k°12 _ DO
<br /> PERMIT#
<br /> \ \)\\LV ►,. 31131f--7 \E o - O 3
<br /> Owner uthorized Agent Signature Date (Revised 10/12/2015)
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