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ILEC 1>r R CAL PERMIT Aril-LIGATION <br /> 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 I vwvw.everettwa.gov/permits <br /> { PROJECT SITE INFORMATION <br /> l_ 2 1 <br /> PROJECT ADDRESS: /52 J ! —' /' S c-t•I + e /7 E✓e%c'_ /- (AM / Cl 5 Z° <br /> BUILDING AREA(if residential,new construction,remodel,or addition) / 2 D SF <br /> BUILDING TYPE: ❑SFR-DETACHED 0 SFR-ATTACHED ❑DUPLEX ❑ MULTI-FAMILY-#OF UNITS: I7YCOMMERCIAL <br /> JUSEOFBUILDING: <br /> ELECTRICAL APPLICATION I6i9FO illIATIIO6\I <br /> CONTRACT PRICE OF WORK:$ 9 - ":' <br /> NUMBER OF DEVICES(if low voltage): <br /> FIRE ALARM? 0 YES f NO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIPTION OF WORK: -�/?5 /t/ I A- I/ ✓7-e�,J h F S a-✓? U c p-� ��S (v <br /> c <br /> N u- t 1 a✓I 1 LS 17 o L`J�} P✓ ✓I k- c ✓1 U Loos <br /> CONTACT INFORMATION. <br /> OWNER NAME: /10 'Ph CA.14) TENANT NAME(If Commercial): L LA.n ft l/1Cv t L 5 <br /> OWNER MAILING ADDRESS: STREET <br /> errY STATE ZIP <br /> OWNER PHONE: 2-0(O-- 2 2 7 - z 2 75fowNER EMAIL: <br /> CONTRACTOR NAME: /J 0..-c_-V\ I e, CT- <br /> c��"e� <br /> �y <br /> CONTRACTOR ADDRESS: STREET L (2 0 / CP' i C- <br /> ony L4l' 5 STATE LA) ZP 98.2/S <br /> CONTRACTOR PHONE: ..2(2)Cp - S52 /3- ( y yCONTRACTOR EMAIL: E.,I CbC C� 4--el '� Cp L 4 T , ✓L� <br /> CONTRACTOR LIC.#(REQUIRED): cz-Lk 4--el S7-7 PYv1 CITY OF EVERETT BUSINESS LIC.#(REQUIRED): 9-39g1 <br /> PRIMARY CONTACT: ❑OWNER 1g.CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: lC7 n a Piiictvi CONTACT PHONE: 22...z0(Q z 7 - 2 2 7 5 <br /> CONTACT EMAIL: <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 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 /> DV q?-,PERMIT# <br /> /r--- 4°/' <br /> OCILI <br /> Owner/Authorized Agent Signature Date (Revised 90/92/2095) <br />