Laserfiche WebLink
iLECT1 AC*L PER ' dT A =r JCATIO <br /> CITY OF EVERETT PERMIT SERVICES <br /> — 3200 CEDAR STREET, EVERETT, WA 98201 <br /> (P)425-257-8810 J FAX 425-257-8857 J (E) everetteps@everettwa.gov J www.everettwa.gov/permits <br /> .: •' a'JEC`if`:SITE INP'®•V'dA`il'ION.,, . ;•• . <br /> PROJECT ADDRESS: 70 30 Law", gai. <br /> BUILDING AREA(if residential,new construction,remodel,or addition) L,1 6 0 SF <br /> BUILDING TYPE: 0 SFR-DETACHED 0 SFR-ATTACHED DUPLEX 0 MULTI-FAMILY-#OF UNITS: 0 COMMERCIAL <br /> USE OF BUILDING: • • <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK:$ ,(p 000 <br /> NUMBER OF DEVICES(if low voltage): <br /> FIRE ALARM? 0 YES CI NO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): • <br /> DESCRIPTION OF WORK: tAi►(t,(„ kW.) &ktt lr / 1fl, ctrJa t/ T�ST*iS CZ) <br /> • - - . . : . . .• -- <br /> • CONTACT INFORMATION <br /> OWNER NAME: Dyw as+y (pGiYt LLC. TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET QQ ROy 1(to <br /> CITY V ii4/6e ' STATE Wit ZIP /,6i rp <br /> OWNER PHONE: 1.0J212 (.15-6 OWNER EMAIL: d9Yl2frf i Ae�si1'Ice rwon .e 64-. ... . <br /> CONTRACTOR NAME: /446.6: s it/Yi .'J Iti(-77Zi/C <br /> CONTRACTOR ADDRESS: STREET ) 57(y 95 A"(/d AfF Q <br /> CITY Lk, 9ete41 STATE /,�/ ZIP 9$o2(1 <br /> CONTRACTOR PHONE: 7 ir 32 ) ZLJL/`7 CONTRACTOR EMAIL: /41(..e Ueve-m1eite-frie- p 4-4 - <br /> CONTRACTOR LIC,#(REQUIRED):.. /et�i,P is e D LII(/ w w a`yss „CITY OF EVERETT BUSINESS LIC.#(SQUIRED):5j tf 90---r4 <br /> PRIMARY CONTACT: 0 OWNER K.CONTRACTOR 0 OTHER(Please Specify) <br /> CO ?Kr NAME: // / CONTACT PHONE: L, � 3 L 7 7/P17 <br /> ( <br /> t`�'{-evee V ir{'-t([ . .. CONTACT EMAIL: /a /1,,ce '?C.@ 014.- 6 .C'Crv"2_ <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 an 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 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 /> PERMIT# <br /> ,. fg F ego 3 v4g <br /> Owner/Authoriz Agent Signature Date (Revised 10/12/2015) <br />