1427 100TH ST SW CLUBHOUSE 2017-06-07

ELECTRICAL PERMIT APPLICATION Of7r 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.everettwa.gov/permits PROJECT SITE INFORMATION PROJECT'ADDRESS: (Ij 3-- Q 2C7-1 Clrl>BhOL�S'e BUILDING AREA(if residential,new construction,remodel,or addition) SF BUILDING TYPE: ❑SFR-DETACHED ❑rS�F�R-ATTACHED Mo bile 11 MULTI-FAMILY-#OF UNITS, 11 COMMERCIAL USE OF BUILDING: ►nobi le fLrKa. Porz-k Io) -too wi t1".$ LECTRI AL APPLICAT16N INFORMATION CONTRACT PRICE OF WORK: $K23LO .!X NUMBER OF DEVICES if low vo to e FIRE ALARM? ❑YES ❑ ASSOCIATED BUILDING PERMIT# if a licable`. DESCRIPTION OF WORK: 4- d-Wp, -ke Gc CONTACT INFORMATION OWNER NAME: 2 ( �f f_ TkICITENANT NAME If Commercial :-Faaw ; e S OWNER MAILING ADDRESS: STREET 239 1a VV a% rt GRT-N VU,n ca vw-P- r V 4J 3M'i a,:6 //1� CITY STATE ZIP 'otS OWNER PHONE: -1tjqOWNER EMAIL: k()1eins&Cd>mv-a.st, hef CONTRACTOR NAME; xt- 41,09 CONTRACTOR ADDRESS: STREET f CITY STATE " ZIP .I. CONTRACTOR PHONE: cl CONTRACTOR EMAIL: er � , Irv, CONTRACTOR LIC.i1(REQt rREt):M del CITY OF EVERETT BUSINESS LIC.#(REQUIRED)- PRIMARY CONTACT: ❑OWNER CONTRACTOR ❑OTHER(Please Specify) CONTACT NAME; CONTACT PHONE: L5 a5cl CONTACT EMAIL: �t=ro -(0rn AGREEMENT;I hereby certify that I have Head and examined this application and know the some to be true and correct. All provisions of laws and ordinances goveming 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 PERMIT# owner/Authorized Agent Signature Date (Revised 9/23/2016)