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ECT ICAC PERMIT AOKICATION <br /> - <br /> NIlay 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@everettwa.govI www.everettwa.gov/permits <br /> PROJECT SITE INFORMATION <br /> PROJECT ADDRESS: 17©1 S Li+L, A v . Fv'e.CG*-4- , L/4 9,?,2.o? <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: 0 COMMERCIAL <br /> USE OF BUILDING: <br /> ELECTRICAL,APPLICATION INFORIIIIATION <br /> CONTRACT PRICE OF WORK:$ 5 0 <br /> NUMBER OF DEVICES(if low voltage): <br /> FIRE ALARM? 0 YES 0 NO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIPTION OF WORK: C LGj C I f C i-J— �o r' kectri—eur vp <br /> CONTACT INFORMATION - <br /> OWNER NAME: Sc.,Cr.r kt-4"-I- 13 r i-F-}t'v. TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET 1 7o I S WI, /twt. <br /> crmi E vc.r4-44- STATE tiA ZIP 9 O Z-0 .S <br /> OWNER PHONE: 1115--, S 79 " Li 3 3'l OWN EMAIL: <br /> CONTRACTOR NAME: Ty 1 Varletet-po 1 Q _� <br /> W L LC. <br /> CONTRACTOR ADDRESS: STREET . <br /> CITY STATE - ZIP <br /> CONTRACTOR PHONE: 360" 3 1 g- 2 CONTRACTOR E A(L: . <br /> CONTRACTOR LIC.#(REQUIRED). VG(,A..d ek S935 'ITY OF EVERETT BUSINESS LIC.#(REQUIRE :OS 7 )g— <br /> PRIMARY CONTACT: 0 OWN 0 CO PF ACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: <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 lam 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 /> . qS .........__. <br /> r PERMIT# <br /> i37 k %*(p(a - 0 g <br /> i ilk <br /> Owner/.uthorized Agent Signatur- Date (Revised 10/12/2015) <br />