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LECT Cie L PEr MIT A�UUCA T ON
<br /> �-�-! CITY OF EVERETT PERMIT SERVICES
<br /> /"4" --1`a
<br /> 3200 CEDAR STREET, EVERETT, WA 98201
<br /> (P)425-257-8810 I FAX 425-257-8857 ] (E)everetteps@everettwa.gov 1 www.everettwa.gov/permits
<br /> PROJEC"I"SITE lli0OR 10.04:.
<br /> PROJECT ADDRESS: '7 If I)O TL St S E v'"Q i'"Q f f
<br /> BUILDING AREA(if residential, new construction,remodel,or addition) SF
<br /> BUILDING TYPE: 0 SFR-DETACHED CI SFR-ATTACHED LI DUPLEX 0 MULTI-FAMILY-#OF UNITS: MCOMMERCIAL
<br /> USE OF BUILDING: `fir- a-'re tik tiLt_S-e .
<br /> EL CI""RICAL AP PL TI -N INFORMA,T$ON
<br /> CONTRACT PRICE OF WORK:$ i 00 ,
<br /> NUMBER OF DEVICES (if low voltage):
<br /> FIRE ALARM? 0 YES Cl NO
<br /> ASSOCIATED BUILDING PERMIT#(if applicable):
<br /> DESCRIPTION OF WORK: A rC.. tAi i‘V, fl i .- 'i`.-+ f''f°'f- Qinivd`y.
<br /> CONTACT INFORMATIO
<br /> /7-\
<br /> OWNER NAME ..1;11,1".S Uv. T Viten P< TENANT NAME(if Commercial):
<br /> OWNER MAILING ADDRESS: STREET i Po gap,; ° c .1
<br /> CITY ' e ..Y t L ( STATE tkA 211. 9 F l
<br /> OWNER PHONE: OWNER EMAIL:
<br /> ..�............. s,.. ..-..,._,.,,_.w..,.y.....,,........a.,..,e. ........xw...u.ruaxw • a... G....�ro.x..r�ve,.a.e a.. .,.M.,... � v a x. . .......ax.....r .-. v. ................w..a....x �_a.w......n...+�vrr..
<br /> CONTRACTOR NAME: . -i . skic .
<br /> CONTRACTOR ADDRESS: STREET g4- KS
<br /> CITY 1A-16.4-: iv ajc STATE " ; ZIP g 8 1,c
<br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: t"ce.kiafe c :.
<br /> CONTRACTOR LIC.#(REQUIRED): '(.I '+ET I.€1 Q CITY OF EVERETT BUSINESS LIC.#(REQUIRED): "' 1!
<br /> ..,_..b... .,..........................�,.ti...,....,.....,.,.,..».... ............................__.....a........... ..,...„.,.........u,...r.........,..,.>..-wo,+. xme.o-.....,............e-«...al,-a.Yr..an...,, ,.«-.................w.-,�+.—..,t...............,,
<br /> PRIMARY CONTACT: 0 OWNER ❑CONTRACTOR 0 OTHER(Please Specify)
<br /> CONTACT NAME: CONTACT PHONE:
<br /> CONTACT EMAIL:
<br /> AGREEMENT.T hereby certify that I have read and examined this application and know the same to be true end connect. 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 i
<br /> comply with the State Contractors Law 98.27 RCW and 296.200 WAC.
<br /> City of Everett Official Use Only
<br /> FEE
<br /> Y? 2r_SO
<br /> PERMIT#
<br /> 1,, 3 CV/Li/t g
<br /> E \ `KCC,- a5
<br /> Owne! ttiorized Agent Signature Date (Revised 90/92/2095)
<br />
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