Laserfiche WebLink
W. LECT ICL PERMIT AIiLICA.TION <br /> -.-,- CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> (P)425-257-8810 j FAX 425-257-8857 j (E)everetteps@everettwa.gov f www.everettwa.gov/permits <br /> PROJECT SITE INFORMATION' <br /> PROJECT ADDRESS: t-11 2_v RC.tG e,{'" R c--) .- <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: COMMERCIAL <br /> USE OF BUILDING: <br /> _ <br /> ELEC RICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK:$ l/C C__,C <br /> NUMBER OF DEVICES(if low voltage):• <br /> FIRE ALARM? 0 YES •,IL.NO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIPTION OF WORK: <br /> 0-‘.' g--c_A-1-- --\--- celf1--- 'Oe..k i_ -0--ye-1--- . <br /> CONTACT INFORMATION . <br /> OWNER NAME: tlyTENANT NAME(If Commercial): 5ec / <br /> OWNER MAILING ADDRESS: STREET <br /> CITY STATE ZIP <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: p Z � f}%�til,€), <br /> CONTRACTOR ADDRESS: STREET '`7i S•t-<—J l i v\e- ‘RD <br /> , <br /> CITY 0 T " I( % STATE 'vZI- 36 7 <br /> CONTRACTOR PHONE: 2(0 --?..:-.--)f'31\ L 'CONTRACTOR EMAIL: "1h -(1 jt'c rC t/ // d 6--,,,,,,I.a2 <br /> CONTRACTOR LIC.#(REQUIRED) V'��^LE2 CITY OF EVERETT BUSINESS LIC. <br /> #(REQUIRED) <br /> 016- <br /> PRIMARY CONTACT: 0 OWNER CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: CSD -- 2-2-7 31 I L <br /> �''1 �- �(/ <br /> CONTACT EMAIL: Vc__ (ilk '/)M4c°' ' <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!am authorized by the owner of this property to perform the work for which application is made and 1 <br /> comply with the State Contractors Law 98.27 RCW and 29E200 WAC. <br /> City of Everett Official Use Only <br /> FEE <br /> A,--12m 5th <br /> PERMIT# <br /> `7-1 '-16 . E 1q60-1 -a <br /> Owne , •oriz d Agent Signature Date (Revised 10/12/2015) <br />