1402 SE EVERETT MALL WAY T MOBILE 2018-09-10

ECTRICAL PERMIT AF _ICATION CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET, EVERETT, WA 98201 (P)425-257-8810 f FAX 425-257-8857 I (E) everetteps@everettwa.gov J www.everettwa.gov/permits PROJECT SITE INFORMATION;. PROJECT ADDRESS: Ee L 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: $ :0(� NUMBER OF DEVICES if low voltage),. FIRE ALARM? ❑YES NO ASSOCIATED BUILDING PERMIT# if applicable : DESCRIPTION OF WORK: ��(� ��l�I?i �'he>✓i2L CONTACT INFORMATION OWNER NAME: tq G TENANT NAME(if Commercial): OWNER MAILING ADDRESS: STREET (� �i� Cz v_e_ ' �y � CITY SFArE ZIP OWNER PHONE: OWNER EMAIL: CONTRACTOR NAME: ✓ (�Q CONTRACTOR ADDRESS: STREET CITY STATEZIP O y CONTRACTOR PHON &- 7-?j CONTRACTOR EMAIL: W9_0_C_&_ 7Z CONTRACTOR LEC.#(REQUIRED)4u" t 0D CITY OF EVERETT BUSINESS L .#(REQUIRED):Os�D PRIMARY CONTACT: ❑ OWNERCONTRACTOR ❑OTHER(Please Specify) CONTACT NAME: CONTACT PHONE: f 9'3 —`7 - 7'�• 1 '8f -_ICONTACT EMAIL: GJ,ff ,, C AGREEMENT:T reby certify that 1 have read and examined this application and know the same to be true and correct Ali provision of 1 ws 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 Cuncel the provisions of any other state or local law regulating construction or the performance of construction. That l am authorized by the owner of this property to perform the work for which application is made and 1 comply with the State Contractors Law 18.27 RCW and 296.200 WAC. City of,Everett Official Use Only FEE PERMIT# 1r E i�n OL9— 0j Owner)Authorized A&Signature Dat (Revised 10/12/2015)