11014 19TH AVE SE CRICKET WIRELESS 2017-04-10

ECTRICAL ERM T 'LICATION CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET, EVERETT, WA 98201 (P)425-257-8810 I FAX 425-257-8857 I (E) everetteps@everettwa.gov www.everettwa.gov/permits PROJECT SITE INFORMATION �� PROJECT ADDRESS://7/ / /"I7 r� .(/J� S/c T� I / .22 7T /j, - BUILDING AREA(if residential, new construction, remodel, or addition) SF BUILDING TYPE: ❑ SFR-DETACHED ❑ SFR-ATTACHED ❑ DUPLEX ❑ MULTI-FAMILY-#OF UNITS: 12'63MMERCIAL USE OF BUILDING: ELECTRICAL APPLICATION INFORMATION CONTRACT PRICE OF WORK:$ lDj1342 NUMBER OF DEVICES (if low voltage): FIRE ALARM? ❑YES IO ASSOCIATED BUILDING PERMIT# (if applicable): DESCRIPTION OF WORK: //67-A--tv(; 7 /2-O it .i t/7G&--/..5 77v0 1V4/ Z/6 1/73 CONTACT INFORMATION OWNER NAME: f//) /4"/../K---0(4"" TENANT NAME(If Commercial): OWNER MAILING ADDRESS: STREET CITY (///f f e 675/ STATE ,/f-t., ZIP OWNER PHONE: 2-417 724 3/3 ( OWNER EMAIL: CONTRACTOR NAME:/7 9 61/V C67) 414-tX--7n h syit , r i N CONTRACTOR ADDRESS: STREET /� CITY f/Lt(d6TaAff k / STATE /474- ZIP Z/ 3 CONTRACTOR PHONE: 3(QQ -?Q 7 -( f&S CONTRACTOR EMAIL: 42V�NGEb�i ca I'LIc 14/�QL1B/Y�J-�'� CONTRACTOR LIC.#(REQUIRED): CITY OF EVERETT BUSINESS LIC.#(REQUIRED): PRIMARY CONTACT: ❑ OWNER ❑ CONTRACTOR 0 OTHER(Please Specify) CONTACT NAME: CONTACT PHONE: CONTACT EMAIL: AGREEMENT. T hereby certify that I have read and examined this application and know the same to be true and correct. All provisions of laws and ordinances governing 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. �1 `, c City of Everett Official Use Only GLilvld. 16- ADVNCS f2�I) 7 FEE PERMIT# Own- • 'thio ' -> Agent Signature Date (Revised 10/12/2015)