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LECCTR C AL PERMIT UCAT •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@everettwagov I www.everettwa.govlpermits <br /> FIFE QEF • <br /> PROJECT ADDRESS: (PDS \J\Y‘ IN\oY\ c'-- - <br /> BUILDING AREA(if residential,new construction emodel r addition) 5 0 SF <br /> BUILDING TYPE: 0 SFR-DETACHED 0 SFR-ATTACHED 0 DUPLEX 0 MULTI-FAMILY-#OF UNITS: 0 COMMERCIAL <br /> USE OF BUILDING: t22-e.._S <br /> ELECTRICAL APP1 ,0CAT1IO q !F®R. ATIION <br /> CONTRACT PRiCE OF WORK:$ 3 0 O v <br /> NUMBER OF DEVICES(if low voltage): <br /> FIRE ALARM? 0 YES 9.NO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): C. t ` — O b C\ <br /> DESCRIPTION OF WORK: c �� �`'e-� D k C Ri/V\. <br /> .. . . ::..:.:. . <br /> . :. ..- ..:..:__.O1!lT.�# Y:iNFORMATI®RI.,-. :. <br /> OWNER NAME: -,G`M-seS (71"--e-301C-- TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: sTRear 6, U 3 1M. /� <br /> 14\J-2.V cm( Pc STATE q,S`ZO \ ZIP <br /> OWNER PHONE:2O C .CUD L17 - OWNER EMAIL: <br /> CONTRACTOR ADDRESS: STREET 1/(;) �j D 2j • j o-ro�.rte_ >�G. J <br /> ►'C�tZ,,,� CITY l/)Vi— STATE 9 e 1 Z -3 ZIP <br /> CONTRACTOR PHONE: 4k-1-5— Ob? 5T j CONTRACTOR EMAIL: <br /> CONTRACTOR LIC.#(REQUIRED): 1405 ' - ' S a CITY OF EVERETT BUSINESS LIC.#(REQUIRED):O 5)1 3 g <br /> PRIMARY CONTACT: DOWNER 0 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: Z U 11 co"A-r 0e- 1� ' CONTACT PHONE: 5 G eA �O I 00 '411 <br /> - <br /> CONTACT EMAIL: <br /> AGREEMENT:T 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 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 i <br /> comply with the State Contractors Law 18.27 RCW and 296.200 WAC. <br /> City of Everett Official Use Only <br /> FEE <br /> PERMIT# <br /> i 136 <br /> Owner/Authorized Agent S gnature Date (Revised 10/12/2015) <br />