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_LECTI CAL PERMIT . :ULQCATiON <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@everettwagov I www.everettwa.gov/permits <br /> PRA JECT SITE IINFOR 0I!®8 ,,• ... . <br /> PROJECT ADDRESS: 19 3 62 Ate,-,;II Creek l�Q�b w�y s'k r � <br /> BUILDING AREA(if residential,new construction,remodel,or addition) 7 O IC SF <br /> BUILDING TYPE: ❑SFR-DETACHED 0 SFR-ATTACHED 0 DUPLEX 0 MULTI-FAMILY-#OF UNITS: I OMMERCIAL <br /> USE OF BUILDING: Ci✓ruCu(T"r41 e1'14 <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK:$ e O OO.to <br /> NUMBER OF DEVICES(if low voltage): <br /> FIRE ALARM? 0 YES 0 NO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIPTION OF WORK: /Oac o'ineciLioviS 514pp/ec J' Rcfs'ovr 4c <br /> C AC ..FORMA O <br /> OWNER NAME: f.4 Teo _ �/ TENANT NAME(If Commercial): �e c. 5 6>r- <br /> OWNER <br /> f✓cry <br /> OWNER MAILING ADDRESS: STREET 19.2(' ,4 e,,'d Cvge.c Rap''h4r� Q <br /> CITY EI/(de7-� 'STATE W/1 ZIP '7V2D3 <br /> OWNER PHONE:(y2.S. C S/- 1300 OWNER EMAIL: :.. <br /> CONTRACTOR NAME: <br /> CONTRACTOR ADDRESS: STREET • <br /> CITY STATE ZIP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> CONTRACTOR LIC.#(REQUIRED): CITY OF EVERETT BUSINESS LIC.#(REQUIRED): <br /> ,..:,,:.. n ......>..>.,...,.w_..::>:.,....„. _. .... .___u .n.. <br /> PRIMARY CONTACT: ❑OWNER 0 CONTRACTOR UG OTHER(Please Specify) ,/I' %14 tcH z s'e e Sceeryi so is <br /> CONTACT NAME: CONTACT PHONE: (92), .93/- V79, <br /> Zet CL ®l 0w6,1 CONTACT EMAIL: Z 04ea:'e�&S-91A5or-r CoGY1 <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 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 296.206 WAC. <br /> City of Everett Official Use Only <br /> FEE <br /> ttif <br /> PERMIT# <br /> 12/G47 `: l� 12- I° <br /> /OP <br /> zed <br /> A. .t Signature Date (Revised 10/12/2015) <br />