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g? °IlikkAIIRICAL PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT,WA 98201 <br /> (P) 425-257-8810 1 FAX 425-257-8857 1 (E) everetteps@everettwa.gov I www.everettwa.gov/permits <br /> 7:;'111413'--,S . hv. tea 1,�• ,�+Za �vfe. ,%W���-2� ��r�a#f��`%e. :_ e .r a'f't_ >g���,�a�Y'.#•roo�t 4 :_�. �€ ..a".�`, . '�;`c` <br /> PROJECT ADDRESS: .(--- C E(m l Yt A,�,,_ <br /> BUILDING AREA(if rr��siden I,new construction,remodel,or addition) rc/(a// H(4 I SF <br /> BUILDING TYPE:43/S -DETACHED 0 SFR-ATTACHED 0 DUPLEX 0 MULTI-FAMILY-#OF UNITS: 0 COMMERCIAL <br /> USE OF BUILDING: <br /> , ;�tiN ELECTRICAL 4:M:KA IO INFORMATION S} { <br /> _ x�,.. sidr,.,rrs 3'- �>- ..,as:,7...;.4i�a,.,�sv�.�cF�w.,>az�._..�,_ ...�*:�.. .xM�r.a._.,,fia' ...i._-e a��:�.`ti�:r.a, .,r..�..�..� 'n��,aw,??.s, i,- _-,-. ..�.oat� Fro-$.�w,o„�S ..utKEc, <br /> CONTRACT PRICE OF WORK: $ Cdr <br /> NUMBER OF DEVICES (if low voltage): <br /> FIRE ALARM? 0 YES 0 NO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIPTION OF WORK: el r�11+- 7-CA- V AC i rt5ial <br /> r'” ,7 CONTACTINFORMATION Z s `` x' <br /> OWNER NAME:leybs Y+I len, TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET let fr <br /> (al „ <br /> CITY ti/ve'�/ i- STATE /^L Z (/�J�' 3 <br /> "' <br /> � <br /> OWNER PHONE: �I15 2- a - 49 OWNER EMAIL:124110 .. C"( . HaV floel ✓i . (J1(77 <br /> CONTRACTOR NAME:13 ve flarnt1?,+^ ^/ Q Ql <br /> CONTRACTOR ADDRESS: STREET 1`t 1U /2�� (J4 1 t J� (I60 I /p�//(( <br /> CITY PIcur1 f1(A -'f,rY a!/-C� STATE 4.1.7f— /ZIP�///7(/L13 <br /> CONTRACTOR PHONE:1"Pi --] I` -ll� 'ttCONTRACTIOR EMAIL: ��(���((CC///// <br /> � �►�o®�Ir�e�(a�����rt= tom <br /> CONTRACTOR LIC.#(REQUIRED):$LUEF 1 1-414 CITY OF EVERETT BUSINESS LIC.#(REQUIRED):0FZ7qo <br /> PRIMARY CONTACT: 0 OWNER CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT <br /> k\an <br /> NAME:I,//11 /0 CONTACT PHONE: 1-ii,✓ 7/1 n—//3�1�q <br /> 1 ( �[ CONTACT EMAIL: ue f i /l yY(crAfy7-I :" V Cary.) <br /> AGREEMENT:T hereby certify that 1 have read exami this application and know the same to be true and correctt. All provisionsinof laws and ordinances governing thi <br /> type of work will be completed whether specified erein 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 lam 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 WAG <br /> City of Everett Official Use Only <br /> FEE <br /> -lso9 <br /> / / PERMIT# <br /> /i /141 E ( S0(0 -005 <br /> Winer/A 1 i•,in _ <br /> In-t Signature / Date (Revised 10/12/2015) <br />