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CITY OF EVERETT PERMIT ••i ICES <br /> °;‘,'"A4rne--4�p <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> (P)425-257-8810 1 FAX 425-257-8857 1 (E) everetteps@everettwa.gov 1 www.everettwa.gov/permits <br /> PROJECT SITE INFORMATION <br /> PROJECT ADDRESS: 1\A 2- )(Kati V A:e1Z OIL. t VPPPe`( W ' ' ZO1 <br /> BUILDING AREA(if residential, new construction,remodel,or addition) SF <br /> BUILDING TYPE:/SFR-DETACHED 0 SFR ATTACHED 0 DUPLEX/ 0 MULTI-FAMILY-#OF UNITS: 0 COMMERCIAL <br /> USE OF BUILDING: Cet tit3p�-eGC, -5014/1 horn?, ryl-jyti <br /> ELECTRICAL APPLICATION iNFORMATION <br /> CONTRACT PRICE OF WORK:$ <br /> NUMBER OF DEVICES (if low voltage): <br /> FIRE ALARM? 0 YES 0 NO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): C t"605- 4a\ n <br /> DESCRIPTIO OF W K: IGy 1 CAA r eI,OtAlci 0OL4C. + e k ne0vV► MIS 4:5. ij x e <br /> 46 �ullftP tr1P S GT 7c�r4 - Rou A ,`n `�►Pt`�Ytiec..1 <br /> Pay►.( _SO 4 L ai>� l; ;A t5 A' �c v <br /> - - - - - CONTACT INFORMATION <br /> OWNER NAME: G t( Rye, r . TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: /STREET II D g L freed,X fat__ Vi f IDit... <br /> /' u CrrY Velgell STATE (1A. ZIP flip! <br /> OWNER PHONE: 3C0 "7 3i; 43 L:.5 C Otf rya n_l`Z g' ,�r�u <br /> OWNER EMAI t �t �Carol <br /> CONTRACTOR NAME: 0 unle Y2.— <br /> CONTRACTOR ADDRESS: STREET <br /> CITY STATE ZIP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> CONTRACTOR LIC.#(REQUIRED): CITY OF EVERETT BUSINESS LIC.#(REQUIRED): <br /> PRIMARY CONTACT: —W--R---0-C-0;;;;;;—.6.-0-;;;;;;;;;;;Er <br /> NER ❑CONTRACTOR` ❑OTHER(Please Specify) a w-- .H,.u.. .. ---------,,---— <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 properly 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 /> 15 �, <br /> PERMIT# <br /> ( r ,?1(/ E ((®7 - 1(03 <br /> nerlAuthorized Agent Signature Date (Revised 10112/2015) <br />