220 SE EVERETT MALL WAY 2017-04-28

ECTRICAL PERMIT AP ICATION Ey 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 PROJECT ADDRESS: �® j. BUILDING AREA(if residential, new construction, remodel,or addition) SF BUILDING TYPE: ❑SFR-DETACHED ❑SFR-ATTACHED ❑ DUPLEX ❑ MULTI-FAMILY-#OF UNITS: 1XCOMMERCIAL [USE OF BUILDING: ELECTRICAL APPLICATION INFORMATION CONTRACT PRICE OF WORK: $ dyg NUMBER OF DEVICES (if low voltage): FIRE ALARM? ❑YES E00 ASSOCIATED BUILDING PERMIT# if applicable).- DESCRIPTION pplicable):DESCRIPTION OF WORK: R,\\- `M f 1 6 r�-_ VA- CONTACT INFORMATION OWNER NAME: Cj TENANT NAME(If Commercial): OWNER MAILING ADDRESS: STREET CITY STATE ZIPO OWNER PHONE: v\`� �� OWNER EMAIL: CONTRACTOR NAME: \ C CONTRACTOR ADDRESS: STREET a ^cc CITY STATEUA\_ ZIP a CONTRACTOR PHONE:�d.� ESQ k� CONTRACTOR EMAIL: CONTRACTOR LIC.#(REQUIRED): CITY OF EVERETT BUSINESS LIC.#(REQUIRED): PRIMARY CONTACT: ❑OWNER ONTRACTOR ❑OTHER(Please Specify) CONTACT NAME: CONTACT PHONE: ONTACT EMAIL: AG ENT.•T hereby certify that I haveea and examined this application and know the same to be true and correct. All prow of laws and ordinances governing this type 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 loc /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/ mply with the State Contractors Law 18.27 RCW and 296.200 WAC. i City of Everett Official Use Only FEE 1a -1�5' 0 PERMIT# os E Owner/.t77rtd g nt 'gnature Dae (Revised 10/12/2015)