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4rErr CTRICAL PERMIT APCATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> (P)425-257-8810 1 FAX 425-257-8857 I (E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> PROJECT ADDRESS: -141(0 f bvm <br /> BUILDING AREA(if residential,new construction, remodel,or addition) SF <br /> BUILDING TYPE: CI-SFR-DETACHED 0 SFR-ATTACHED 0 DUPLEX 0 MULTI-FAMILY-#OF UNITS: 0 COMMERCIAL <br /> USE OF BUILDING: <br /> �'� 'h�"�""•, <br /> ; m• s& F - ksta � 4pt „ . r 111,172:,;40044-41110, 4n40,„ %ii l + i11h i,� i s <br /> CONTRACT PRICE OF WORK: $ IOC) <br /> NUMBER OF DEVICES (if low voltage): <br /> FIRE ALARM? 0 YES 0 NO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIPTION OF WORK: \ `--S-c-74 bw. <br /> (io a tis�h1 ri u`'.b'NS „�r ( �N� qt i�VzaNry_e "0"�, m <br /> OWNER NAME: 3 <br /> fit. S 1 5(�l TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRE : STREET 1 1 U Yv k.- t {-�Q <br /> CITY CSN.��,{L.Q/�\ STATE ek_ ZIP 1 g 2 <br /> OWNER PHONE: X - �� �2(C OWNER EMAIL: <br /> CONTRACTOR NAME �i� (7Y1 Gt.l�� l�/V` �dl 1(�``(Giti.•J <br /> 11 <br /> CONTRACTOR ADDRESS: STREET A.9(/D� <br /> CITY 1`A`Iti' t7�•(�� STATES �" ZIP I&��O <br /> CONTRACTOR PHONE: � L o• S� •�� CONTRACTOR EMAIL: Li u : . Yl r�Q-G�;(1 <br /> CONTRACTOR LIC.#(REQUIRED): l C �p3�-� CITY OF EVERETT BUSI ES�(REQUIRED): DS S$ <br /> PRIMARY CONTACT: 0 OWNER FLCONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: apd 16b <br /> 6CONTACT EMAIL: 'I 6 fot,e.,vy, ceyn <br /> AGREEMENT.I 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 verning this type <br /> 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 I <br /> comply with the State Contractors Law 18.27 RCW and 296.200 WAC. <br /> City of Everett Official Use Only <br /> íÔ <br /> ; PERtxz <br /> , Z u c� E <br /> Owner/A thorized Agent Signature ate (Revised 9/23/2016) <br />