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%;a4 LECT[ i1CPERI L IT Al PLIC ATI(•N <br /> --- CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> (P)425-257-8810 FAX 425-257-8857 f (E) everetteps@everettwa.gov www.everettwa.gov/permits <br /> • PROJECT:SITE.INFO MATI®>I ' <br /> PROJECT ADDRESS: S(yO \A}. pi,(� (� G 19 v ai IASA g),(011 <br /> 6 i)VistiQ q(3.- <br /> BUILDING <br /> (3.BUILDING AREA(if residential,new construction,remodel, or addition) SF S E 6,x4 L01 A K11, <br /> BUILDING TYPE: 0 SFR-DETACHED 0 SFR-ATTACHED 0 DUPLEX 0 MULTI-FAMILY-#OF UNITS: xiCOMMERCIAL <br /> USE OF BUILDING: O r C I C <br /> ELECTRICAL.APPUCAT10NI 100404T104.: <br /> CONTRACT PRICE OF WORK:$ 1 J I OO , O() <br /> NUMBER OF DEVICES(if low voltage): c S 5 <br /> FIRE ALARM? 0 YES ` -ONO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): 1 I <br /> DESCRIPTION OF WORK: fie_ G� l� coil ScTY ucf o I, re,O,.5 v):4 , i,,`�" S <br /> cii CGS t�J� <br /> ONTAC'I';INFORMATION. <br /> OWNER NAME: 'Do e 0'1 1 TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET )(}(). U' C tl 5I 110 iL <br /> CITY �l/e✓'ef STATE UM ZIP 7 g,�oyci <br /> OWNER PHONE: �^ OWNER EMAIL: <br /> CONTRACTOR NAME: JV 0)C O✓v, <br /> CONTRACTOR ADDRESS: STREET 16 3 140&I I u.mt. U v' <br /> CITY Fe Af 0 n STATE )1\O ZIP 4 3 OA <br /> CONTRACTOR PHONE: 10b'3g - S 0 7b CONTRACTOR EMAIL: \ 11171 4 t4 c,i)yin S f 16 to s <br /> CONTRACTOR LiC,#(REQUIRED): 1 V L r f,L I CITY OF EVERETT BUSINESS LIC.#(REQUIRED): 0S5 <br /> PRIMARY CONTACT: 0 OWNER CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: ),06, - v itt <br /> Se,t e ri it Y\ CONTACT EMAIL: ) i)A >`1 et-a". S /C'" Y7'l <br /> AGREEMENT:T hereby certify that l 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 t <br /> comply with the State Contractors Law 98.27 RCW and 296.200 WAC. <br /> City of Everett Oficial Use Only <br /> FEE <br /> 2.L(2 . 5(:)1 <br /> PERMIT# <br /> 9 g E S(D( — (c) <br /> OwnerlAut orized Agent nature Date (Revised 90/92/2095) <br />