210 SW EVERETT MALL WAY GOODWILL 2019-11-19

ELECTRICAL PERMIT APPLICATION CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET, EVERETT. WA 98201 (P)425-257-8810 1 FAX 425-257-8857 1 (E)everetteps@everettwa.gov I WWW,everefta.gov/permitS PROJECT SITE INFORMATION PROJECT ADDRESS: Cqu) 5kv cvev -H, Alf-4" ill-� BUILDING AREA(if residential,new construction,remodel,or SF BUILDING TYPE: 0 SFR-DETACHED 0 SFR-ATTACHED 0 DUPLEX 0 MULTI-FAMILY-#OF UNITS-' �7COMMERCIAL ..................... IUSE OF BUILDING, ELECTRICAL APPLICATION INFORMATION CONTRACT PRICE OF WORK: S - NUMBER OF DEVICES(if low voltage): FIRE ALARM? 0 YES 1:91160 ASSOCIATED BUILDING PERMIT#(if applicable): DESCRIPTION OF WORK: 14r_e, CONTACT INFORMATION OWNER NAME: 4:00d2A.jt4L, TENANT NAME If Commercial): OWNER MAILING ADDRESS: S,'If, 10 zip OWNER PHONE: JOWNER EMAIL: CONTRACTOR NAME: Anb_b/4 S —rel CONTRACTOR ADDRESS: SIAH, 2— CONTRACTOR PHONE: SW ICONTRACTOR EMAIL. _1'ertric4- r0bbf,'eJ_ CONTRACTOR LIC.±REQUIRED): Poeh et 1?4t J-b CITY OF EVERETT BUSINESS LIC.#(REQUIRED):0 9 q PRIMARY CONTACT., 11 OWNER CONTRACTOR 0 OTHER(Please Specify) ................................... ... CONTACT NAME: ]D2JI CONTACT PHONE' , — SLi"j 4_ -S �ONTAEMAIL, 4GREEMENT. Thoroby codify that I hive read,wd mvmunuvi this apvkalwn and know the sankto ho 01fo amftvtroct. Alt provisions of laws and ottPoanogs governing In,$ type of work watt tnk comploted whelhor specified hoevot a,ml, rhogranbq,00 peftul does ON pe&suriv to gree auftvdy 10 WoNto or cmiot the jr&visions of apy ofhc.i slatc,or crai iaw reqWatin, q constnrz hors or the portwenance of cortstrurtion That I am authoozed by the owner of this ptoparty to pedrYin tht work for Which apps cation is made and I camply with the State Contractors Law 18,27 RCW and 296,200 WAC City of Everett Of cial Use Ori"), FE PERMIT# 0wner/Adhor1zoaAqerAjSja1ure Cate (Rev�st�d 70'12/W15)