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"IP ECS 1CL PERMIT ANLICATION <br /> Nimay 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@everettwa.gov I www.everettwa.gov/permits <br /> PROJECT SITE IN FORMATION <br /> PROJECT ADDRESS: 9v--?..... Iv e,itsoD_4 l,(J&4 LUycia 6 vt/il- J <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: OMMERCIAL'—' ) <br /> USE OF BUILDING: <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK:$ 1 00 0 ,09/ <br /> NUMBER OF DEVICES(if low voltage): <br /> FIRE ALARM? 0 YES pit NO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): 16 IR 06— 0 SID . <br /> DESCRIPTION OF WORK: �c-�� <br /> 1 ,- c. 1.--;G1`�I ) <br /> ykik ittr-1 10 Li/ RiI SG7Vl j L(�]!' <br /> CONTACT INFORMATION . <br /> OWNER NAME: TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET <br /> CITY STATE ZIP <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: >1 ��7y,.. A 'D 04 I O. i— Eoli j, ( . <br /> .,, <br /> CONTRACTOR ADDRESS:(tg2-2 STREET 2_5(4 vo�j <br /> CITY • \V` VN STATE r i ZIP YID 2 c <br /> CONTRACTOR PHONE: 6.-'DS .,QQL§ CONTRACTOR EMAIL: 1 vl9II O?) ITS a 4 v.(1,.f 1. Ct'?Li <br /> CONTRACTOR LIC.#(REQUIRED): ��.,G ,. 0 iiJ (.-- d'z7�5 CITY OF EVERETT BUSINESS LiC.#(REQUIRED): <br /> PRIMARY CONTACT: OWNER `gCONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT"� NAME: CONTACT PHONE: 2_i Ir,U .S j$ <br /> —A/i4n CONTACT EMAIL: 11/190 114,4]6) cj Ifi'!n i/. % <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 l am authorized by the owner of this properly 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 /> . 4, 21,, - e, <br /> PERMIT# <br /> 0 er/Authorized Agent Signature4. Date (Revised 10/12/2015) <br />