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-LEC 1]-RACAL PER IT A LICAT O N <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@everettwa.gov vvww.everettwa_gov/permits <br /> 1 PR 8i #ECT SITE INFORM TI Itt <br /> PROJECT ADDRESS: 1 k Z 5 Y ' --4 IC o v c- N1.VE {� u2�eta- <br /> I BUILDING AREA(if residential,new construction, remodel, or addition)( 5-0 0 SF - <br /> BUILDING TYPE: 0 SFR-DETACHED 1 SFR ATTACHED 0 DUPLEX ❑MULTI-FAMILY-#OF UNITS: 0 COMMERCIAL <br /> • <br /> (pJ <br /> USE OF BUILDING: ,_e g-1.A P In c 51 <br /> ELECTRICAL APPLICATION INFORMATION.. <br /> CONTRACT PRICE OF WORK:$ 7 00. 0 0 <br /> NUMBER OF DEVICES(if low voltage): <br /> FIRE ALARM? 0 YES Pc <br /> NO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIPTION OF WORK: 1\J C t (Ns ftp 14 S d R e� I C c UI g c - Ili 4T , <br /> t`I cic CJViQ Sl . <br /> :'. ..... . .:.' .... :... : .'"• -CONTACT . <br /> s. °�T a �}M A - .. .. <br /> OWNER NAME: c(u Cvc e 6 t(e-d1 rn TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET t L(Z 51M Q v\ 9- AVE <br /> f �p <br /> CITY Ev ,r STATE W A- ZIP J <br /> OWNER PHONE: f OWNER EMAIL: <br /> CONTRACTOR NAME: NA-- t •I p C TY Ce-I ,( ..�. ... . . . .,..w.. <br /> CONTRACTOR ADDRESS: STREET <br /> CITY J STATE ZIP <br /> CONTRACTOR PHONE: 25* 02,2 - G54 3-d CONTRACTOR EMAIL: old-e I C c t s I C 9--I(I) g�!%I Q t I _ co po <br /> CONTRACTOR LIC.#(REQUIRED): CITY OF EVERETT BUSINESS LIC.#(REQUIRED): 55S(5- Z <br /> PRIMARY CONTACT: lA OWNER 0 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: 2 ©(; _g _ g <br /> 1 K CONTACT EMAIL: <br /> AGREEMENT:T hereby certify that 1 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 l <br /> comply with the State Contractors Law 18.27 RCW and 296.200 WAC. <br /> City of Everett Official Use Only <br /> FEE <br /> kizla <br /> PERMIT <br /> 0 I I ° g E 14004° - ea <br /> Owner/Authorized Agent Signature Date (Revised 10/12/2015) <br />