620 112TH ST SE SPACE 162 2019-08-16

� E<.�CT�RI�iA� ��VI��' /4P�OCI�T�I��1 CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET, EVERETT, WA 98201 (P)425-257-8810 � FAX 425-257-8857 � (E) everetteps@everettwa.gov � www.everettwa.gov/permits PROJECT SITE INFORMATION PROJECT ADDRESS: � ` L> ' 7N 't S C � � BUILDING AREA(if residential, new construction, remodel, or addition) SF BUILDING TYPE: ❑SFR-DETACHED ❑ SFR-ATTACHED ❑ DUPLEX ❑ MULTI-FAMILY-#OF UNITS: ❑COMMERCIAL USE OF BUIL�ING: ELECTRICAL APPLICATION INFORMATION CONTRACT PRICE OF WORK: $ U_� NUMBER OF DEVICES (if low voftage): FIRE ALARM? ❑YES ;� NO ASSOCIATED BUILDING PERMIT#(if applicable): DESCRIPTION OF WORK: (�j 'j `� r 1 N � ��Z,�=�� ;v � � a !'� � — � �1– 1 CONTACT INFORMATION OWNER NAME: V � v�.. Q %— ENANT NAME(If Commercial): OWNER MAILING ADDRESS: sTREEr CIN �:—I STATE W/1 ZIP Jg�J -- OWNER PHONE: "F`'Z S ' Z�f— �-,f� L � OWNER EMAIL• � i Q(• � �C " � �"G CONTRACTOR NAME: CONTRACTOR ADDRESS: sraaeET CIN STATE ZIP CONTRACTOR PHONE: CONTRACTOR EMAIL: CONTRACTOR LIC.#(REQUIRED): CITY OF EVERET7 BUSINESS LIC,#(REQUIRED): PRIMARY CONTACT: C�OWNER ❑CONTRACTOR ❑OTHER(Please Specify) CONTACT NAME: CONTACT PHONE: �—f'2� � � �—�� L�-. l��r�r� ��D�(��.—��. CONTACT EMAIL: � L'�C��t� � a �JI.U�^i � , �C�.� AGREEMENT.�T hereby certify that/have read and examined this application and know the same to be true and recf. I rovisions of I s and ordinances governing this type of work will be completed whethe�specifred herein or not. The granting of a permif does not presume to give authority to violate or cancel the provisions of any other state or local law regulating consfrucfion or the performance of construcfion. That I am authorized by fhe owner of thrs property to pertorm the work for which application is made and l comply with fhe Sfate Contractors Law 18.27 RCW and 296.200 WAC. City of Everett Official Use Only FEE -. ..9ii�5�z��1,d.��/i��Y� Ty �._ F � �A �--s .� :.� PERMIT# . � f � ,�' � S - 3 0 `�? ��0� ` _ er/A gent Si�ature Date (Revised 90/12/2015)