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hLECTR CAI PERMIT ACAT ON <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 I (E) everetteps@everettwagov] www.everettwa.gov/permits <br /> PRJECTSIITJIMF o •M TI N • <br /> PROJECT ADDRESS: (00 7 S E E 4(lug Way c i 9 41 <br /> BUILDING AREA(if residential,new construction,remodel, or addition) SF • <br /> BUILDING TYPE: 0 SFR-DETACHED 0 SFR ATTACHED ❑DUPLEX 0 MULTI-FAMILY-#OF UMTS: COMMERCIAL <br /> ,USE OF BUILDING: <br /> >ELECTR tAL APPLICATION IN>FOR A`l1'ION.. <br /> CONTRACT PRICE OF WORK:$ $n o, <br /> NUMBER OF DEVICES(if low voltage):• <br /> FIRE ALARM? 0 YES ,NO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): N Gut <br /> DESCRIPTION OF WORK: A-CU e C. t iptAze - tZo(7- WK-Ct—I.tDctr IM,e-k{' <br /> 1 <br /> ,:. .C. ...TAC = <br /> . ..r. T INFORMAT1Att1OWNER NAME: gk1�,-s/ Fliri�; v 4 TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS STREET (p p"l rj g.t4-- tvILi i IALIA/ lj f 2 °� f} #$ COSr w) <br /> 1.. (_ CITY ( STATE �n� ZIP Q CU l7 <br /> OWNER PHONE: 1194)- t(o�J ` OS 4 J OWNER EMAIL: --- <br /> CONTRACTOR <br /> rCONTRACTOR NAME: 141 04 i--/VlC C o . <br /> CONTRACTOR ADDRESS: STREET (.”00 airitAacc.A.,4- <br /> / 5d-e.-3o 3 <br /> /�'( <br /> CITY t//Creek, STATE V* ZIP q��Z. <br /> CONTRACTOR PHONE: 1{Z.5" ' 9- NO Z. CONTRACTOR EMAIL: (i,j etzy 7(7 e AL• �(M <br /> CONTRACTOR LIC.#(REQUIRED)• ke-A4am,j CIT / LIC.#(R D): tfyy 3 <br /> Y OF EVERETT BUSINESS EQUIRE <br /> PRIMARY CONTACT: ❑OWNER [,.CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: 7A--` 3s-1- ( o7.— <br /> , M((((✓,cAlooPi CONTACT EMAIL: 4150K k y 717 c 40L,Co HI <br /> AGREEMENT:T hereby certify that 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 t 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 1827 RCW and 296.200 WAC. <br /> City of Everett Official Use Only <br /> FEE <br /> 4147 11(0 • <br /> IPERMIT# <br /> �;�.---&-6CJ (Z e/7 E (j 12' D5� <br /> Owner/Authorized Agent Signature Date (Revised 10/12/2015) <br />