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HLECTRCAL PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> (P)425-257-8810 j FAX 425-257-8857 I (E) everetteps@everettwa.gov I www.everettwa.gov/permits <br /> PROJECT ADDRESS: 3 � 1 (<r 0 v)r (e--v <br /> BUILDING AREA(if residential,new construction,remodel,or addition) SF <br /> BUILDING TYPE: IF SFR-DETACHED 0 SFR-ATTACHED 0 DUPLEX 0 MULTI-FAMILY-#OF UNITS: 0 COMMERCIAL <br /> USE OF BUILDING: RQ.../-( e rylia L <br /> CONTRACT PRICE OF WORK:$ CQ (70°V <br /> NUMBER OF DEVICES(if low voltage): <br /> FIRE ALARM? ID YES 0 NO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIPTION OF WORK: 't r\f ( 1 j y1G I - '7'6 C t r- r > 1 e x'" r1 f(O , <br /> 'PrO -ex(f+(f, /4- /fie err u?yr C ( r`c v / n e(A) h a`pump /0 (67,7 o <br /> _. CoNTAbT <br /> OWNER NAME: Li F}f1 0 q 80 I P_r-ciC TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET 3 3.Z / k.r'©I4 e <br /> ern' �r r'C J STATE (j,/ ZIP 9OR=2,61 <br /> OWNER PHONE:.„2O6- 3/3 " ?6,6-7 OWNER EMAIL: 95 <br /> CONTRACTOR NAME: A//�J/,r J�f- N v9 (.)tt P_( LL 1 <br /> CONTRACTOR ADDRESS: STREET j6.., / 2? )' t- cI'-(A} <br /> CIN i v\(J(Ct(SCO STATE jj' - SP <br /> CONTRACTOR PHONE: 4/2S--S i�7- 'fitC? CONTRACTOR EMAIL: ki--ar ( e_L%TZ L-C_L(S9r6i[ OGt <br /> CONTRACTOR LIC.#(REQUIRED): <br /> ,..,,,./4a l6& bE Z.v.._m CITY OF E..Vx <br /> E,u=R.,.E:.TT,BU,S:.:INE.:.SS...LIC.#(REQUIRED) <br /> Q1±. <br /> „ .., <br /> PRIMARY CONTACT: ,ZI OWNER 0 CONTRACTOR 0 OTHER(Please Specify) fila( <br /> CONTACT NAME: (u h o q CONTACT PHONE:_2 0(o -3 13 _cp6 �7 <br /> CONTACT EMAIL: W. <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 lam 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 296.200 WAC. <br /> City of Everett Official Use Only <br /> FEE <br /> PERMIT# <br /> 61111°\ C) d-\ -�? Fl €*— O21 <br /> Owner/Authorized Agent Signature Date (Revised 10/1212015) <br />