|
OLT ElliF PERMIT APFCATION
<br /> CITY OF EVERETT PERMIT SERVICES
<br /> 3200 CEDAR STREET, EVERETT,WA 98201
<br /> (P)425-257-8810 I FAX 425-257-8857 1 (E)everetteps@everettwa.gov www.everettwa.gov/permits
<br /> :. }PROJECT SITE�.1N�'O��VIATtONx
<br /> PROJECT ADDRESS: a ,Rev $.4Q TPS
<br /> BUILDING AREA(f residential new construction,remodel,or addition)ho t'�e- 1 O I CO _ S� LO r S S
<br /> BUILDING TYPE: I4R-DETACHED 0 SFR ATTACHED 0 DUPLEX 0 MULTI-FAMILY-#OF UNITS: 0 COMMERCIAL
<br /> USE OF BUILDING: 6, •� (� k� �� ,
<br /> z ` +ELECTRICI�L APPLfCA ION INFORMATION
<br /> �,,.:. _,..w� _ _,, .,. .� _.«. .�._ .:_.,J, 3..,.%ia r�.,�-:��1,...��,.:'F,�k� ,,...-,_reae.«,�r s�.-.-.� _,�».a�a•, �...- . .. ..
<br /> CONTRACT PRICE OF WORK:$ a 2.)c)Q ?
<br /> NUMBER OF DEVICES(if low voltage):
<br /> FIRE ALARM? 0 YES C94O
<br /> ASSOCIATED BUILDING PERMIT#(if applicable): n
<br /> DESCRIPTION OF WORK: R; Se m-aa� P ry\ k 0 _' ' P
<br /> r 4 � ,� ., .: ! f$h I -t i' � t u -,s z e y� - + \a 1s a F Y - �y {, 1
<br /> s f', s .*, t.Y h1 -, � T a, 4�'* -'�r'y '� W. u r y a •` IY
<br /> . �,aw. _„ ,�v N x... < ..�.. .. �s �_ CONTA, ..NFORNfAT10NV.,., , .. .0 .._ .. .. ... . : ..... .__ .r._. , ....
<br /> OWNER NAME: 3® 1Le-9.o_ TENANT NAME(If Commercial):
<br /> OWNER MAILING ADDRESS: STREET (:)2 ac) —9 J� _9+r-4-e. 3--r�e
<br /> CITY CV��e-f-f" STATE L3 fl �]ZIP /8ao
<br /> OWNER PHONE:1{aEj_ 3 L-}l- q54-i 3 OWNER EMAIL:
<br /> CONTRACTOR NAME: / 4 E L c Y' G cr) 7{-e v-- ec t`L@
<br /> CONTRACTOR ADDRESS: STREET e© ( 5 - 441 FA,,d2 , L •e) y T H
<br /> CITY Li/OA) (.0, Q STATE (R� ZIP 980
<br /> 4
<br /> CONTRACTOR PHONE: 4Q�j_`7 7 7(7 O C) 1Q CONTRACTOR EMAIL: rn reteG cc tr-pc,"Ve t7—Seqi-f L
<br /> CONTRACTOR LIC.#(REQUIRED): MRF LEEGA.90 Q ' CITY OF EVERETT BUSINESS LIC. REQUIRED): CD5158� con')
<br /> PRIMARY CONTACT: ❑OWNER ONTRACTOR 0 OTHER(Please Specify)
<br /> CONTACT NAME: CONTACT PHONE:
<br /> CONTACT EMAIL:
<br /> AGREEMENT:I 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 type
<br /> 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 /> ,/ IIP PERMIT#
<br /> 40011
<br /> of
<br /> S. a 2c5/ 3 E ‘-t?t,41,
<br /> OwnerlAut'orized •ent Sig• ture Date (Revised 9/23/2016)
<br />
|