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ILEO ICL PERMIT AikICATI I"illigCITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET, EVERETT, WA 98201 (P)425-257-8810 1 FAX 425-257-8857 1 (E) everetteps@everettwa.gov 1 www.everettwa.gov/permits PROJECT SITE INFORMATION' 4-PROJECT ADDRESS: I. OI WA I I S!'. BUILDING AREA(if residential,new construction,remodel, or addition) SF . BUILDING TYPE: 0 SFR-DETACHED 0 SFR ATTACHED 0 DUPLEX 0 MULTI-FAMILY-#OF UNITS: 0 COMMERCIAL USE OF BUILDING: 4 C A ELECTRICAL APPLICATION INFORMATION.. CONTRACT PRICE OF WORK:$ 2 Ot O NUMBER OF DEVICES(if low voltage):, FIRE ALARM? 0 YES ONO ASSOCIATED BUILDING PERMIT#(if applicable): 4 DESCRIPTION OF WORK: reps/ wire, new sevitid eC, /.:3Z,4,e'ecePf lti,.al i red tr., CONTACT INFORMATION. OWNER NAME: ShO VI i (Ain TENANT NAME(If Commercial): OWNER MAILING ADDRESS: STREET CITY STATE ZIP OWNER PHONE: OWNER EMAIL: CONTRACTOR NAME: D If V r .W CONTRACTOR ADDRESS: STREET CITY STATE ZIP CONTRACTOR PHONE: CONTRACTOR EMAIL: ' CONTRACTOR LIC.#(REQUIRED): CITY OF EVERETT BUSINESS LIC.#(REQUIRED): PRIMARY CONTACT: 0 OWNER 0 CONTRACTOR 0 OTHER(Please Specify) CONTACT NAME: CONTACT PHONE`"(q 2 s) 75 f .4/91 7 de-C1.4d1en_tz.5444 CONTACT EMAIL: iC n AGREEMENT:T hereby certify that I hay ead and examined this application and know the same to be true and correct. All provisiol`7}s of laws and ordinancg governing this 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 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 comply with the State Contractors Law 18.27 RCW and 296.200 WAC. City of Everett Official Use Only FEE 4t \OZ PERMIT# l' r/ / E L�OI - OLIO a 10/2/20 Owner/Authorized Age S'.nature D'ate (Revised10/12/2015)