1701 121ST ST SE 2016-10-28 - Laserfiche WebLink

�ECTRICAL PERMIT A�LICATION CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET, EVERETT, W,4 9a201 (P) 425-257-8810 � FAX 425-257-8857 �(E) everetteps@everettwa.gov � www.everettwa.gov/permits PROJECT S�TE 1NFDRMATIpN PROJECT ADDRESS: 1701 121 st Stree SE Everett WA 98204 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: Apartlllellt C0171p1eX CONTACT INFORMATION OWNER NAME: Charter Club Apartments TENANT NAME (If Commercial): Charter Club Apartments OWNER MAILING ADDRESS: sTREET 1701 121st Street SE arv EV2fett srnrE �NA ZiP 98204 OWNER PHONE: (206) 215-9700 OWNER EMAIL: CONTRACTOR NAME: Lumenal Lighting CONTRACTOR ADDRESS: sTREer 21706 66th Avenue West cirv Mountlake Terrace srnre WA ziP 98043 CONTRACTOR PHONE: 425-481-5001 CONTRACTOR EMAIL: Service@lumenal.com CONTRACTOR LIC. #�REQuiRE�): LUMENLL864LW CITY OF EVERETT BUSINESS LIC. #(REQUIRED):#052486 PRIMARY CONTACT: ❑ OWNER � CONTRACTOR ❑ OTHER (Please Specify) CONTACT NAME: CONTACT PHONE: 425-481-5001 DeWayne Simpson/Johanna Doick coNTacT EnnAi�: Service@lumenal.com AGREEMENT: T hereby certi(y that I have read and examined this application and know the same to be true and correct. A/l 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 authonty to violate or cance/ the p�ovisions of any other state or local law regulating construction or the performance of construction. That I am authorized by the owner of this propeRy to perform the work for which application is made and I comply with the State Contractors Law 18.27 RCW and 296.200 WAC. DeWayne Simpson 6-7-2016 Owner/Authorized Agent Signature Date City of Everett Official Use Only FEE � `�� ,, PERMIT # E � ��- D�� (Revised 10/12/2015)