1205 CRAFTSMAN WAY PORT OF EVERETT 2017-04-19

SAN L ECTRICAL PERMIT Al - _ICATI®N ozy'!L CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET, EVERETT, WA 98201 (P) 425-257-8810 1 FAX 425-257-8857 1 (E) everetteps@everettwa.gov I www.everettwa.gov/permits PROJECT SITE INFORMATION cc PROJECT ADDRESS: `j10L s 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: ELECTRICAL APPLICATION INFORMATION CONTRACT PRICE OF:WORK: $ A(' o NUMBER OF DEVICES (if low voltage): FIRE ALARM? ❑YES 16NO ASSOCIATED BUILDING PERMIT# (if applicable): DESCRIPTION OF WORK: 7A C NTACT INFORMATION OWNER NAME: Q TENANT NAME(If Commercial): OWNER MAILING ADDRESS: STREET ` C� CITY STATE kX ZIP OWNER PHONE: .i �' OWNER EMAIL: CONTRACTOR NAME: CONTRACTOR ADDRESS: STREET 10191 A? CITY ASTATE W14 ZIP D CONTRACTOR PHONE: CONTRACTOR EMAIL: CONTRACTOR LIC.#(REQUIRED): CITY OF EVERETT BUSINESS LIC.#(REQUIRED): PRIMARY CONTACT: ❑OWNER CONTRACTOR ❑ OTHER(Please Specify) CONTACT NAME: CONTACT PHONE: A,A /'b?,('/Z CONTACT EMAIL: AGREEMENT:Thereby certify that I have read and examined this application and know the same to be true and correct. All provisi ns of lams 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/am authorized by the owner of this property to perform the work for which application is made and/ comply with the State Contractors Law 18.27 RCW and 296.200 WAC. City of Everett Official Use Only FEE PERMIT# &/44// Ei (� Owner/Au ¢ed Agent Signature Date (Revised 10/12/2015)