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kECTRICAL PERMIT AIILICATION <br /> °1111 _ CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 1 (E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> �� �.. PRO. ECT SITErINFO MATION �� .. <br /> 11•111111111 <br /> PROJECT ADDRESS: 113419 Gf L 41. <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: 0 COMMERCIAL <br /> USE OF BUILDING: <br /> ,:mootomoqtimmtomnmrEtkdfitidAoAooutAitibNifwditmAiifiskrooxoio.pmiRpmpvva <br /> ,_..r.:,o..n d7Yv.m..,x n�. W,r ,.,da�'ce..e=;..���"td,_.m.�..rsm3t�.;.. r-m.t .za....maw.,..S,,�.,,+� r,.,, rte. .a ._.;•,. . ,,,.,s-�.. _... ,� .. .., w,._,, ,. ....._ .K.o. ...,r_., .a.7�..�:r <br /> CONTRACT PRICE OF WORK:$ 260 <br /> NUMBER OF DEVICES (if low voltage): <br /> FIRE ALARM? 0 YES 0 NO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIPTION OF WORK: R, ,P Lrat ((„/ a _i L <br /> ttfMlgninrtellittttt=UICOIN:tkdti*t**ttOzsnIMIMMEIOMVMtIM, <br /> OWNER NAME: kreR4-0L-SMV TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET /7.0 ! Cif!4'4- --1 <br /> CITY Eli ,n.fr— STATE AIA ZIP 7f2Q/ <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: ,t_V itki4 x_ fDk '/�+ j►� <br /> CONTRACTOR ADDRESS: STREET 3CrO I £I!IL Zf' //�-J/� <br /> CITY /�VS4E STATE w ZIP ?p �// <br /> CONTRACTOR PHONE: LOS 02S? 1/( / CONTRACTOR EMAIL: <br /> CONTRACTOR LIC.#(REQUIRED) it LA4j f f 1 I ZL CITY OF EVERETT BUSINESS LIC.#(REQUIRED) <br /> PRIMARY CONTACT: 0 OWNER 0 CONTRACTOR .OTHER(Please Specify) 'ltt'fIC((4y(/ &lI Av',QL ' <br /> CONTACT NAME: CONTACT PHONE: G Z 3 / 22 <br /> lo CONAvvf CONTACT EMAIL: <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 I 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 /> Oog /c7 <br /> dta- <br /> 2 Oo <br /> PERMIT# <br /> iP �� ,• EV) 11.008 -03 <br /> Ow r/Authorized Agent Signature Date (Revised 10/12/2015) <br />