|
.SLC CCTRQCCAL PEERiMIIT AIWICATflON
<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 1 www.everettwa.gov/permits
<br /> PROJECT ADDRESS: S t7a' l"t`U G.C LJe.. 6-V G f t
<br /> BUILDING AREA(if residential,new construction,remodel, or addit o� n) k I Z( SF .
<br /> BUILDING TYPE:j,KfSFR-DETACHED 0 SFR-ATTACHED 0 DUPLEX 0 MULTI-FAMILY-#OF UNITS: 0 COMMERCIAL
<br /> USE OF BUILDING: F12_,
<br /> ELECTRICAL APPUCATION INFORMATION
<br /> CONTRACT PRICE OF WORK:$ 4 S.j •
<br /> NUMBER OF DEVICES(if low voltage):
<br /> FIRE ALARM? 0 YES 0 NO
<br /> ASSOCIATED BUILDING PERMIT#(if applicable): G I tO 1 TUZ 1.
<br /> DESCRIPTION OF WORK:
<br /> j .
<br /> .
<br /> ;CONTACT;IIetFORMATION..
<br /> OWNER NAME: H k j 1-', .1-3 y rte,/S TENANT NAME(If Commercial):
<br /> OWNER MAILING ADDRESS: STREET 3� )Si/ 1 r Z t 514i ` Se.
<br /> t
<br /> COY G V e�r /�/ l STATE w 4 ZIP el CJ e-CiU•
<br /> OWNER PHONE: OWNER EMAIL:
<br /> CONTRACTOR NAME: LA(.a t r J rte. IS,) 01^1^,c, -
<br /> Ste
<br /> CONTRACTOR ADDRESS: STREET ' 2 /l rJ 4 C c'N.)4...K c.(/C r e
<br /> eTY STATE ZIP
<br /> CONTRACTOR PHONE:01/5.D
<br /> Z, . ' -O&G CONTRACTOR EMAIL: bG(.,,:, 1,-,,A,,,, s e Ai s,✓e GDM.
<br /> CONTRACTOR LIC.#(REQUIRED): Z)Zggi .-_ogoo CITY OF EVERETT BUSINESS LIC.#(REQUIRED):
<br /> .-. -._...._-. .,-.�rr:_.:,��.:,,.-..Y�..-- ..,...: ,.....u-,.....--...,.-__.,,..<wN.....,-.....Y.....,..,-... ._s.,_,.:—..,.. .w..r.__.. —.=xw-v.-.,. ..F,... - -._w, ., ..,,<.... ...._---.-._f.......-_r,_..--
<br /> PRIMARY CONTACT: 0 OWNER 0 CONTRACTOR 0 OTHER(Please Specify) G
<br /> CONTACT N ME: CONTACT PHONE: i/Z,1 Z 4:3`i U O a-) •
<br /> C.ccZoo, G CONTACT EMAIL: `
<br /> lig G -- B®✓� e S �'�. fio�-)
<br /> AGREEMENT:T hereby certify that l 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 wi/l 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 1
<br /> comply with the State Contractors Law 18.27 RCW and 296.20b WAG.
<br /> City of Everett Official Use Only
<br /> FEE
<br /> . q S _____-_-___
<br /> PERMIT#
<br /> \Z.,(Z-Z(,-/7._ I 1=- l,q-k 'Z. — 'q-g
<br /> Owner/Authorized Agent Signature Date (Revised 10/12/2015)
<br />
|