1000 SE EVERETT MALL WAY DEPT OF EARLY LEARNING 2017-01-13

�ECTRICAL PERMIT AF�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: ��j ��L V � �T� )''ll � j�l� ' � i 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: Q �— �� C ELECTRICAL APPLICATION INFORMATION CONTRACT PRICE OF WORK: $-�j rj �� NUMBER OF DEVICES (if low voltage): FIRE ALARM? ❑ YES NO ASSOCIATED BUILDING PERMIT #(if applicable): ,rj /51 � - � DESCRIPTION OF WORK: �C-j" - I►`.� _� �J t�C. �-} l�� !� � �-��L�S �� tir�% LcT C.3 � ��<: � t_� CONTACT INFORMATION OWNER NAME: �/l—� I �;�— � 2, L ��%N1TENANT NAME (If Commercial): OWNER MAILING ADDRESS: sTReer CITY STATE ZIP OWNERPHONE: �� I��a l ��P� OWNEREMAIL: CONTRACTOR NAME:� i'�E �� R �l7 (_, LC C. j�! L CONTRACTOR ADDR�SS: srREET �(� F�EJ � I Z O ��i � ] CITY ,� C � �, STATE �% �' ZIP C�� J CONTRACTOR PHONE: � Z5 -J � (�j� 2 CONTRACTOR EMAIL: � E�1 n� C� ,�t-ei f�C�� LL�I��C� .�� CONTRACTOR LIC. #(REQ D): CITY OF EVERETT BUSINESS LIC. #(REQUIRED): PRIMARY CONTACT: ❑ OWNER � CONTRACTOR ❑ OTHER (Please Specify) CONTACT NAME: CONTACT PHONE: L} Z .r�� =j � � � � �� K��-' f-i �-�--1 T/� C� CONTACT EMAIL: �� Y� L AGREEMENT: T hereby certify that 1 have read and examined ihis application and know the same to be true and correct. All provisions of laws and ordinances governing fhis type of work will be completed whefher specified herein or not. The granting of a permif does not presume to give authority to violate or cancel the provisions of any other state or local law regulating consfrucfion or the performance of construciion. That l am authorized by the owner of this property to perform the work for which applicafion is made and I comply wifh the State Contractors Law 18.27 RCW and 296.200 WAC. Owner/Authorized Agent Signature ► q 1� Date Cify of Everett Official Use Only FEE � � 0� PERMIT # E �(�� (Revised 90/12/2095)