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::,,,10*,1:1'.,,,,,,,„,,,,,„—. , _ T 1LECTR COAL PERMIT A_ TION <br /> O <br /> „osigifCITY OF EVERETT PERMIT SERVICES <br /> r <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> (P)425-257-8810 J FAX 425-257-8857 I (E) everetteps@everettwagov I www.everettwa.gov/permits <br /> P;R0j QCT SITE IIN*ani. ,T O • ' - <br /> PROJECT ADDRESS: CACI A /_.{74,-(7 _ 3 et4 i i(A'n <br /> BUILDING AREA(if residential,new construction,remod el, or addition) pba SF 6- \/ <br /> BUILDING TYPE: 0 SFR-DETACHED ❑SFR-ATTACHED 0 DUPLEX 0 MULTI-FAMILY-#OF UNITS: COMMERCIAL <br /> USE OF BUILDING: <br /> ELECTRICAL APPUUCA°ITION MN FORMA`1Ol�l <br /> CONTRACT PRICE OF WORK:$ f oo s <br /> NUMBER OF DEVICES(if low voltage):, f 1-6 <br /> FIRE ALARM? 0 YES ____\1-1\10 <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIPTION OF WORK: —k4)1-17'- ' CI ft$A(—)-- • <br /> CON AC ...: .-.M . . <br /> . : -: - . . ,. -.::T.>.. T;lNFOR:..=ATiON.. ..:: <br /> OWNER NAME: Rob, � r.)cm___.- TENANT NAME(If Commercial): p\i r2,/o, bet <br /> OWNER MAILING ADDRESS: STREET Pf r're i-1, , ` ml�f�CSZ ) iil i n r <br /> Crry STATE ZIP ii <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: ,���� .,I e.. .. .. ... . . . .... <br /> CONTRACTOR ADDRESS: STRE/ETT t I .1.-4 e L :�, 15O1 ,^�(`l <br /> CITY rY ` IN (-2/ <br /> J STATE ZIP✓y�})1 6 <br /> CONTRACTOR PHON(L d.. )3�,_0 4 7 CONTRACTOR EMAIL:t..)t.i--c,D Q.t� Co n c c -• -x-74^ <br /> CONTRACTOR LIC,#(REQUIREJD)• (� ? GL1 .#(R D):0�j ,11 <br /> . CITY OF EVERETT BUSINESS LIC SQUIRE <br /> PRIMARY CONTACT: ❑OWNER EATRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: 1„ ) 1' <br /> . /C0-. T)--el CONTACT EMAIL: LX 5 <br /> 0`e, CO CGe e•-•1'/ -'. <br /> AGREEMENT T hereby certify that I have read and examined this application and know the same to be true and correct: Al rovisions of laws and ordinances governing this <br /> type of work will be completed whether specked 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! <br /> comply with the State Contractors Law 98.27 RCW and 296.200 WAC. <br /> City of Everett Official Use Only <br /> FEE <br /> je • <br /> OP , <br /> 6,) 5-9 , <br /> PER # <br /> __ ; 1 J hI-112, - IL( <br /> Owner/A "rift-- Ig an Lure Date l7 <br /> (Revised 90/92/2095) <br />