900 PACIFIC AVE BASE FILE 2017-10-18

AECTRICAL PERMIT AP*ICATION CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET, EVERETT, WA 98201 (P)425-257-8810 1 FAX 425-257-8857 ( (E)everetteps@everettwa.gov I www.everettwa.gov/permits PROJECT SITE INFORMATION PROJECT ADDRESS: j4 ✓r L tJu/Lf-4- BUILDING - BUILDING AREA(if residential, new construction, remodel,or addition) SF BUILDING TYPE: ❑ SFR-DETACHED ❑ SFR-ATTACHED ❑ DUPLEX ❑ MULTI-FAMILY-#OF UNITS: ZCOMMERCIAL USE OF BUILDING: S r loc? J-�J 6-e44- ELECTRICAL -e44-ELECTRICAL APPLICATION INFORMATION CONTRACT PRICE OF WORK: $ 3 C)C' s" NUMBER OF DEVICES (if low voltage): FIRE ALARM? ❑YES $NO ASSOCIATED BUILDING PERMIT# if applicable): DESCRIP�TION OF WORK: rxt�c� 2. Ct (—C ��fi ( oLzvie CONTACT INFORMATION OWNER NAME: re ;c /K.et�,CC. ( TENANT NAME(If Commercial): f vci-e 4- C( ,:(L- OWNER MAILING ADDRESS: STREET CTY STATE ZIP OWNER PHONE: OWNER EMAIL: CONTRACTOR NAME: V ie-c fr"C CONTRACTOR ADDRESS: S-REET -PO M CRY - 1 STATE 4%;4 Zip S e l o CONTRACTOR PHONE:AoV &11 34P "S2GU CONTRACTOR EMAIL: CONTRACTOR LIC.#(REQUIRED): V EGtr r'-_UZS 42-XkL) CITY OF EVERETT BUSINESS LIC.#(REQUIRED): PRIMARY CONTACT: ❑ OWNER .CONTRACTOR ❑OTHER(Please Specify) CONTACT NAME: CONTACT PHONE: p�- prr� S t4QjA+�•i' L:1 CONTACT EMAIL: �� cj� y,,aC�tx:c�� AGREEMENT:T hereby certify that l 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 4 PERM{T# ��zl E � � 0�� I�-CP Owne uthorized gent Signature Date (Revised 10/12/2015)