15 SW EVERETT MALL WAY BASE FILE 2018-05-02

F7LECTRICAL PERMIT 7LICATI®N CITY OF EVERETT PERMIT VICES 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 INF RMATION PROJECT ADDRESS: ^ (e C 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: LZL ELECTRICAL APPLICATION INFORMATION CONTRACT PRICE OF WORK:$ NUMBER OF DEVICES (if low voltage): Lg FIRE ALARM? ❑YES NO ASSOCIATED BUILDING PERMIT#(if applicable): DESCRIPT OF WORK: l i Cc CX k A e . CONTACT INFORMATION I,A OWNER NAME: 7 �, TENANT NAME(If Commercial): OWNER MAILING ADDRESS: STREET CITY V 1. li STATE ZIP G _ OWNER PHONE: 7js OWNER EMAIL: CONTRACTOR NAME: `- r CONTRACTOR ADDRESS: STREET CITY kj d4 STAT ZIP CONTRACTOR PHONE: CrrONTRACTOR EMAIL: r(G CONTRACTOR LIC.#(REQUIRED): � 1 i stow CITY OF EVERETT BUS ESS LIC.#(REQUIRED): PRIMARY CONTACT: ❑ OWNER ONTRACTOR ❑ OTHER(Please Specify) CONTACT NAME: CONTACT PHONE: L CONTACT EMAIL: r AGREEMENT:Thereby certify that/have read and examined this application and know the same t4 be true and correct.ill 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/ comply with the State Contractors Law 18.27 RCW and 296.200 WAC. City of Everett Official Use Only FEE � /,0 .* o PERMIT# OwnerlAuthorized Agent Signature e (Revised 10/1212015)