1402 SE EVERETT MALL WAY BASE FILE 2016-08-03

4E7r. SECTRICAL PERMIT AFOLICATION CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET, EVERETT, WA 98201 (P) 425-257-8810 I FAX 425-257-8857 1 (E) everetteps@everettwa.gov I www.everettwa.gov/permits • PROJECT SITE INFORMATION PROJECT ADDRESS: (.402- S V/,VON{ P- /u ILI/ Uhl BUILDING AREA(if residential, new construction, remodel, or addition) SF BUILDING TYPE: ❑ SFR-DETACHED ❑ SFR-ATTACHED ❑ DUPLEX ❑ MULTI-FAMILY-#OF UNITS: COMMERCIAL USE OF BUILDING: Mall all ELECTRICAL APPLICATION INFORMATION CONTRACT PRICE OF WORK: $ / 15-00 ck NUMBER OF DEVICES (if low voltage): FIRE ALARM? ❑ YES 0 NO ASSOCIATED BUILDING PERMIT#(if applicable): DESCRIPTION OF WORK: e1ptura. .t ,,I ,`n bq�;,� p'� cJ I`,r, "' re f- I/4 ?/ IflaII U � CONTACT INFORMATION OWNER NAME: 11. 1/- ilia a/►�to 1/ ` TENANT NAME(If Commercial): OWNER MAILING ADDRESS: STREET / /o 2. SI' 1 vrA C T/ a)// Inky CITY ).vrtA,e p- STATE 1/1419" ZIP 9 kZ ek OWNER PHONE: Z S-- Z Z -7/q OWNER EMAIL: CONTRACTOR NAME: q /4 Inni It, it efk CONTRACTOR ADDRESS: STREET J/ 0 0 /91t,Tr, // (,, k /2)- CITY /Lvm eSTATE 1A44- ZIP 69k7 e1� p' CONTRACTOR PHONE: 9'i f L t-3 Z -7 2, CONTRACTOR EMAIL: S-�j#in Q. ti'1,4.1,-)L a 64.41-N r CONTRACTOR LIC.#(REQUIRED):VL(}' 'C/t1 J 1//,b CITY OF EVERETT BUSINESS LIC.#(REQUIRED):0 Z,Z,5"S-A PRIMARY CONTACT: 0 OWNER /`k CONTRACTOR 0 OTHER(Please Specify) CONTACT AME: CONTACT PHONE: (11.1-3 z�_ ? j'2 0 604/ t.'3. im CONTACT EMAIL: S e c„. // 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 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 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 comply with the State Contractors Law 18.27 RCW and 296.200 WAC. City of Everett Official Use Only FEE i Pti PERMIT# gi.e.///& E iLa 04— ( 33 Owne uth ized Agent Signatur Date 9 (Revised 10/12/2015)