11030 EVERGREEN WAY REC BLDG 2017-07-14

� � �LECTRICAL PERMIT A�LICATION CITY OF EVERETT PERMIT SERVICES 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: �D p �� r�-,r/ Gt��¢ BUILDING AREA (if residential, new construction, remodel, or addition) SF BUILDING TYPE: ❑ SFR-DETACHED ❑ SFR-ATTACHED ❑ DUPLEX ❑ MULTI-FAMILY -# OF UNITS: OMMERCIAL USE OF BUILDING: �oMh'��'4/ �( L. 4 5�r. c.� e � bvr �C-�"r e ELECTRICAL APPLICATION INFORMATION' CONTRACT PRICE OF WORK: $ /� p v a NUMBER OF DEVICES (if low volta e): FIRE ALARM? ❑ YES O ASSOCIATED BUILDING PERMIT # (if applicable): DESCRIPTION OF WORK: n S �/ G /'ii u�v � o roo �? hri( G t�✓ i �o ( roo� CONTACT INFORMATION OWNER NAME: m C 0� /�r TENANT NAME (If Commercial): OWNER MAILING ADDRESS: srReer � /YL �-' CITY STATE ZIP OWNER PHONE: OWNER EMAIL: CONTRACTOR NAME: rp w� rL � � CONTRACTOR ADDRESS: srREET v CITY e/'�� STATE �/`� ZIP � 17 Z� CONTRACTOR PHONE: 2� � 3 cl `a K CONTRACTOR EMAIL: h tC� " -- 're('i� �( Lc� C, CONTRACTOR LIC. #(REQUIRED): (�[��T�°`3 �'( ��— CITY OF EVERETT BUSINESS LIC. #(REQUIRED): I� a � PRIMARY CONTACT: ❑ OWNER �CONTRACTOR ❑ OTHER (Please Specify) � � CONTACT NAME: CONTACT PHONE: �f Z S' 3 3 R� Y �/ � /Ut t��` � M M�� CONTACT EMAIL: K � c� � c� —'�G � c�'�Y' � L.Cc� AGREEMENT: T herebvi certifv that I have read and examined this application and know the same to be true and correc . All provisrons of laws and ordinances qovernina this type of work will be completed whether specified herein or not. The granting of a permit does not presume fo 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 pertorm the work for which application is made and I comply with the State Contractors Law 18.27 RCW and 296.200 WAC. '%:�G�/� i�''"`�`—� �2 - o� - � �— Owner/Authorized Agent Signature Date City of Everett Official Use Only FEE 4�/�� ��L%, PERMIT # E �.� � a - o�� (Revised 10/12/2015)