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CITY OF EVERETT PERMIT SERVICES
<br /> 3200 CEDAR STREET, EVERETT, WA 98201
<br /> (P)425-257-8810 I FAX 425-257-8857 J (E)everetteps@everettwa.gov f www.everetfwa.gov/permits
<br /> . - PROJECT SITE INFORMATION •
<br /> PROJECT ADDRESS: 71c i(.''t I" Si S E gt f 4 1 &ve i i t-,w(./i` gt'fo
<br /> BUILDING AREA(if residential,new construction,remodel,or addition) SF
<br /> BUILDING TYPE: ❑SFR-DETACHED 0 SFR-ATTACHED 0 DUPLEX ❑MULTI-FAMILY-#OF UNITS: ( COMMERCIAL
<br /> USE OF BUILDING:
<br /> ELECTRICAL APPLICATION INFORMATION
<br /> CONTRACT PRICE OF WORK:$ j - , t (:
<br /> NUMBER OF DEVICES (if low voltage):
<br /> FIRE ALARM? 0 YES 0 NO
<br /> ASSOCIATED BUILDING PERMIT#(if applicable):
<br /> DESCRIPTION OF WORK:
<br /> 1/ r111114, fI) ;, i ie 1-C' i:.l e i..: -H A C Lk t L r'f-
<br /> CONTACT,INFORMATION
<br /> OWNER NAME• ((i kit crt P rt., ';'-t-i f',` TENANT NAME(If Commercial):
<br /> OWNER MAILING ADDRESS: STREET +j- 0 /6 cvx 1 ;°3 C S
<br /> CITY E l d?_G e f _ 9
<br /> STATE t :1't zip S-2c,'
<br /> OWNER PHONE; S 5-CF ' G'1 C OWNER EMAIL;
<br /> CONTRACTOR NAME: .�, c' f(,_..I 1.4 tr�..__..w.......
<br /> D'f:Sie ti
<br /> re
<br /> CONTRACTOR ADDRESS: STREET FC ,per- STET
<br /> CISf
<br /> CITY w'iSd T STATE imi ZIP Cc
<br /> -
<br /> CONTRACTOR PHONE: 0 Z 34 I S7 CONTRACTOR EMAIL: ,. kc L`I : ) 0,41-'lot , t'isvvt
<br /> [f�
<br /> CONTRACTOR LIC.#(REQUIRED): c, „ ,. Ct �' CITY OF EVERETT BUSINESS LIC.#(REQUIRED):(,�'c 7;li 1
<br /> w«w.T,......,�m..•,..,.,,..n w.�.a. ......,v. w. .,.... ...............— .. -.-.....,.m....... .3w.«............,....w+sw.......i.... ,......�4.r.*ww., �n-.K,...,..o.. .,.,.....--..w...-,......-'h.-.....n -�.. ....._........�..'...,,.,
<br /> PRIMARY CONTACT: 0 OWNER IQ CONTRACTOR ID OTHER(Please Specify)
<br /> CONTACT NAME: CONTACT PHONE:( 1) 7
<br /> 13'05(t,,,. �� '7 Gt 7 J (--r��p_�
<br /> cf , CONTACT EMAIL: Li,-)se e G e't"f f'i C'to(r CIA i G ,kC.., (i 14
<br /> AGREEME=NT'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 ar cancel the provisions of any other state or
<br /> local law regulating construction or the performance of construction. That/em 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 /> FEE
<br /> 41 (5,'-',%
<br /> PERMIT##
<br /> 1
<br /> .4 tl i -"', i (.7./13 i 1 ,,e E i I - be4
<br /> Owner/.uthorized Agent Signature Date (Revised 10/1212015)
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