1402 SE EVERETT MALL WAY BASE FILE 2016-10-20

ESCTRICAL PERMIT APP&ATION CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET, EVERETT,WA 98201 (P)425-257-8810 FAX 425-257-8857 I (E)everetteps@everettwa.gov www.everettwa.gov/permits PROJECT SITE INFORMATION J ' PROJECT ADDRESS: /u"L%. ° vf. ':% t° L• .?.4 c le. BUILDING AREA(if residentlal,new construction,remodel,or addition) BUILDING TYPE: ❑SFR-DETACHED ❑SFR-ATTACHED ❑ DUPLEX ❑MULTI-FAMILY-#OF UNITS: COMMERCIAL USE OF BUILDING: i ELECTRICAL APPLICATION INFORMATION I CONTRACT PRICE OF WORK: $ NUMBER OF DEVICES If low voltage): FIRE ALARM? ❑YES NO i ASSOCIATED BUILDING PERMIT# if applicable): DESCRIPTION OF WORK: G'1 . ; �� ✓�i�= Lr c CONTACT INFORMATION OWNER NAME: ( �' t l- r/ TENANT NAME(If Commercial): OWNER MAILING ADDRESS: STREET CITY : - STATE V ZIP 3 OWNER PHONE: OWNER EMAIL: CONTRACTOR NAME: CONTRACTOR ADDRESS: STREET CITY STATE ZIP CONTRACTOR PHONE: ° ` ` Z' tCONTRACTOR EMAIL: CONTRACTOR LIC.#(REQUIRED): Z i, i ttj Gt% CITY OF EVERETT BUSINE LIC.#(REQUIRED): ! PRIMARY CONTACT: ❑OWNER CONTRACTOR ❑OTHER(Please Specify) CONTACT NAME: / CONTACT PHONE: G' CONTACT EMAIL: AGREEMENT"T Vereby certify that 1 have read and examined this application and know the same to be true and correct_ All provislons oNevd and ordinances governing this type of work will bb completed whether specilied 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 t comply with the State Contractors Law 16.27 RCW and 290.200 WAC. City of Everett Official Use Only FFF PER IT It Owner/Authorized Aifent Signature Date (Revised 10/1212015)