1402 SE EVERETT MALL WAY SPACE 380 MAURICES 2017-01-13

�ECTRICAL PERMIT A LICATION CITY OF EVERETT PERMIT S VICES 3200 CEDAR STREET, EVERETT, WA 98201 (P) 425-257-8810 � FAX 425-257-8857 �(E) everetteps@everettwa.gov � www.everettwa.gov/permits PROJECT SITE INFORMATION PROJECT ADDRESS: � �� ;r ;^ � F. BUILDING AREA (if residential, new construction, remodel, or addition) �� 2..� SF BUILDING TYPE: ❑ SFR-DETACHED ❑ SFR-ATTACHED ❑ DUPLEX ❑ MULTI-FAMILY -# OF UNITS: COMMERCIAL USE OF BUILDING: ELECTRICAL APPLICATION INFORMATION CONTRACT PRICE OF WORK: $ � `.� — NUMBER OF DEVICES (if low voltage : L FIRE ALARM? ❑ YES ❑ NO ASSOCIATED BUILDING PERMIT # if applicable : DESCRIPTION OF WORK: `� .,. � — CONTACT INFORMATION OWNER NAME: — �'' ' TENANT NAME (If Commercial): i� OWNER MAILING ADDRESS: sTUEer r 1�• c �; � � r �� 0 CITY �, /` � STATE r � ZIP � � � OWNER PHONE: OWNER EMAIL: CONTRACTOR NAME: "�. �` .� CONTRACTOR ADDRESS: srReeT ��.� L 1� r-. - �" � ciTr � srnre ziP C V CONTRACTOR PHONE: - �� ;� -' � C. CONTRACTOR EMAIL:• � �. � -�. • � • � - - CONTRACTOR LIC. #(REQUIRED): � �j �•y� �,., CITY OF EVERETT BUSINESS LIC. #(REQUIRED): �� ' � PRIMARY CONTACT: ❑ OWNER �ONTRACTOR ❑ OTHER (Please Specify) CONTACT NAME: CONTACT PHONE: ', � � � �� CONTACT EMAIL: AGREEMENT: T her by certify that I have read and examined this application and know the same to 6e true and correct. All provisions of laws and oidinances governing this type of work will be completed whether speci�ed 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 1 comply with fhe State Contractors Law 18.27 RCW and 296.200 WAC. gnature Date City of Everett Official Use Only FEE � �� i PERMIT # E [ � ��'' l�1' (Revised 10/12/2015)