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i41677 <br /> LE T I PE I PPLI I <br /> C R CAL RM T A N CAT ON <br /> CITY ODF 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 INFORMATION qQ <br /> PROJECT ADDRESS: 3o&3 bili (?i$/46 Aid &&/Lt7rf (/(//r /82-®3 (W-OZ-) <br /> BUILDING AREA(if residential,new construction,remodel,or addition) ‘o),,010SF <br /> BUILDING TYPE: ❑ SFR-DETACHED ❑ SFR-ATTACHED 0 DUPLEX 0 MULTI-FAMILY-#OF UNITS: Kr COMMERCIAL <br /> USE OF BUILDING: M(x Al ux. t2-( A <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK: $ 75/ <br /> NUMBER OF DEVICES(if low voltage)): N/A <br /> FIRE ALARM? 0 YES 'NO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): [si6o9'-x I <br /> DESCRIPTION OF WORK: ,4-R4 fh/57?AJ' svBST g 77DN WO-O-I-/ it)€,4.v. c=k.^. <br /> T rite /Zoei 'ref o f 6 'O-5 2 SV T-tar <br /> 95-02- <br /> CONTACT <br /> 5-a2CONTACT INFORMATION <br /> OWNER NAME: Qc5//l.Y ` ii t7 7—��/L TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET C:03 (A)4937 641 hoe <br /> CITY rveier STATE & A ZIP "8243 <br /> OWNER PHONE: L"Zg-3-,33O"/gd/p l%/� OWNER EMAIL: <br /> CONTRACTOR NAME: V6 ill j2 /NE, <br /> CONTRACTOR ADDRESS: STREET � go. <br /> X 0 <br /> 4/ <br /> CITY y�. i� STATE 1// ZIP moy <br /> CONTRACTOR PHONE: 2-a9 <br /> 3c/Cy CONTRACTOR EMAIL: <br /> CONTRACTOR LIC.#(REQUIRED): v CJl�/t �C SYZAu CITY OF EVERETT BUSINESS LIC.#(REQUIRED):CO 4"qcifY <br /> PRIMARY CONTACT: ❑OWNER ❑CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: 266 3 -9 <br /> .&/at( 9fiff- CONTACT EMAIL: e5,01,,,/,‘,, /�J� CT 7 U1,69 COM <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 <br /> comply with the State Contractors Law 18.27 RCW and 296.200 WAC. <br /> City of Everett Official Use Only <br /> FEE <br /> kk2 <br /> PERMIT# <br /> �_ � ", 25-80 E ; w)sole115' <br /> OwnerlAuthorized Agent Signature Date (Revised 10/12/2015) <br />