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±LECCTR CAL PERI ilT AlPfUCAT Ol <br /> '7- <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@evereftwa.gov J www.everettwa.gov/permits <br /> PROJECT SITE 9NFORIAT9O `: <br /> PROJECT ADDRESS: q?-,� ) \---10,c8 Q sQ ,sas.d VQ <br /> i ,c'�VA. )t'% `tea LO <br /> BUILDING AREA(if residential new construction,remodel, or addition) SF <br /> BUILDING TYPE: 0 SFR-DETACHED 0 SFR-ATTACHED 0 DUPLEX 0 MULTI-FAMILY-#OF UNITS: bMMERCIAL <br /> USE OF BUILDING: ` �%L->0 <br /> (ELECTRICAL APPLICATION 9.NFORMATII e N - - <br /> CONTRACT PRICE OF WORK:$ E_,,S, 0 O' <br /> NUMBER OF DEVICES(if low voltage):, a , <br /> FIRE ALARM? 0 YES X410 <br /> ASSOCIATED BUILDING PERMIT#(if applicable): ` 1 <br /> DESCRIPTION OF WORK: tt Cit e'S �V\�c C \ j CQ V v D Yl a\ 'IC:: 1 ,,-,--N ?©floc <br /> `:; • ' •GONTACT7NFOR1it1ATioN::: <br /> OWNER NAME: �Q -?,0 TENANT NAME(If Commercial): \�>} <br /> OWNER MAILING ADDRESS: s-raeEr ` .-01 40,�d QQO� di <br /> `� <br /> CITY c_ V STATE h' ZIP C� <br /> OWNER PHONE: ---"-- OWNER EMAIL: "—"' <br /> CONTRACTO:R'NAME: '`:\ e $• �.�N -� _ <br /> CONTRACTOR ADDRESS: V STREET E3 CY 1 \•` c1 Sk i' <br /> CRY < VcCt t;-}D i \'—'41 CA STATE k_ok � ZIP v L4 LIi S <br /> CONTRACTOR PHONE:.'IR' . 3 Ol LA CONTRACTOR EMAIL: 6.0 LOL,(.1\-Y, l' t, � t L @ t-,r,to, ; I. <br /> CONTRACTOR LIC,#(REQUIRED)` `� L. 'C <br /> LI A CiTY OF EVERETT BUSINESS LIC.#(REQUIRED):L21 :7)--- <br /> PRiMARY CONTACT: pl.l.iDWNER 0 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: F. C 3 r"-2. 1%\ , -2....SD J LL <br /> , (( _ti CAA (( 't 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 lawsrdinances 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! <br /> comply with the State Contractors Law 18.27 RCW and 296.200 WAC. <br /> City of Everett Official Use Only <br /> FEE <br /> f. <br /> / PERMIT# <br /> ,,,i a ;— \ $DS <br /> Cg. 02I I <br /> ill. . . . ed Ag- ignature k Date (Revised 10/12/2015) <br />