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ELECTi ;CAL PE !MIT �\PPUUCATION
<br /> I ►' a = . CITY OF EVERETT PERMIT SERVICES
<br /> ` ` 3200 CEDAR STREET, EVERETT,WA 98201 .
<br /> (P)425-257-8810 J FAX 425-257-8857 1 (E) everetteps@everettwa.gov l www.everettwa.gov/permits
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<br /> PROJECT ADDRESS: 1-[b'o2• ( t a 1 ifotUn -11-tio
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<br /> DUILDING AREA(If residential,new construction,remodel,or additlon
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<br /> BUILDING TYPE: El'SFRt DETACHED ID SFR-ATTACHED CI DUPLEX LI MULTI-FAMILY-#OF UNITS: NI COMMERCIAL
<br /> USE OF aUILDING: J O 1?G E U CETT
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<br /> CONTRACT PRICE OF WORK:$ -7, coo •
<br /> NUMBER OF DEVICES(if low voltage):
<br /> FIRE ALARM? CI YES liq NO
<br /> ASSOCIATED BUILDING PERMIT#(if applicable): + •
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<br /> DESCRIPTION OF WORK: t Pf E\ \ null ('4 d-'76Z_0 'too Et.v..IC1
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<br /> _FtE:. .,., .. ,-', -.-. _.' ".. . ,. ,t.0,.13 TArCT;_INFORR1,111 1,TtON . . . _ ,_ ,{
<br /> OWNER NAME: TENANT NAME(If Commercial): 1106
<br /> OWNER MAILING ADDRESS: maser pa Ea( 3707 .
<br /> crry .5EkrT'LESTATE Wit ZIP' /2q 2207
<br /> OWNER PHONE: l OWNER EMAIL:
<br /> CONTRACTOR NAME: 61617,,, (4Q,•9,ZJ,57�) ,(,lie.. /01
<br /> CONTRACTOR ADDRESS: STREET Pa Box -4t� ," t l j
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<br /> CONTRACTOR PHONE:426-214-6144 CONTRACTOR EMAIL: k4-ei. Him/AEe4 k/I wl r, 60m
<br /> CONTRACTOR LEC,#(REQUIRED): GE�Iftt ge.. . "t�t�1 CITY OF EVERETT l USINESS LIC.#(REQUIRED):01-1O ,,��.,..f;,:
<br /> 10
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<br /> PRIMARY CONTACT: El OWNER I4 CONTRACTOR ID OTHER(Please Specify)
<br /> CONTACT NAME: • CONTACT PHONE: 206-73 6-45 M
<br /> . I f 1J 415 6k.b W CONTACT EMAIL: DEKA/1 nj be.Div a kikyv1 T. d_,O/y)
<br /> AGREEMENT::Thereby certify that I have read and examined this application and know Ms same to be true and correct AU provisions of laws and ordaiances governing this
<br /> type of work will be completed whether speckled herein ornot. The granting ore permit does not presume to give authority to violate or cancel the provisions of any other slate or
<br /> local law regulating construction(trifle performance of construction. That I am authorized byihe owner of this properly to perform the work for which application is made end I
<br /> comply with the State Contractors Law 18.27'ROW and 290200 WAC
<br /> City of Everett Official Use Only
<br /> FEE.$ 2_.i 5C3
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<br /> PERMIT#
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<br /> i / E12)65 Ol
<br /> Owner) u or zed Agent Signature Date (Revised 10/12/2016)
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