1007 SE EVERETT MALL WAY 2017-05-23

ELECTRICAL PERMIT APPLICATION 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 156 PROJECT,tSITE INFORMATION PROJECT ADDRESS: v �y , LL �V BUILDING AREA(if residential, new construction, remodel, or addition) SF BUILDING TYPE: ❑ SFR-DETACHED ❑ SFR-ATTACHED ❑ DUPLEX ❑ MULTI-FAMILY-#OF UNITS: P<80MMERCIAL USE OF BUILDING: ELECTRICAL APPLICATION INFORMATION CONTRACT PRICE OF WORK: $ 7 �( NUMBER OF DEVICES (if low voltage): /�—� FIRE ALARM? ❑YES 42'NO ASSOCIATED BUILDING PERMIT#(if applicable): DESCRIPTION OF WORK: C-6 02 Glf (fa ;rL_tY� CONTACT INFORMATION NAME: DA A)/v �✓ll_L 14 95J/(/ TENANT NAME(If Commercial): OWNER MAILING ADDRESS: STREET OCJ L�'�1� � �</lAGL �✓ / //tL rxy CITY -� STATE Gt//�J ZIP Q UCJ OWNER PHONE: O/WWiG 6 NER EMAIL: / CONTRACTOR NAME: C, C /cel L C CONTRACTOR ADDRESS: STREET S"„lv 37 Lv CITY �y✓C/,�C�dlSTATE � ZIP CONTRACTOR PHONE: oZ 32,3 F S CONTRACTOR EMAIL: C•GS'Q/^YL"7 Gi p .� CONTRACTOR LIC.#(REQUIRED): G/RL d 1`� S CITY OF EVERETT BUSINESS LIC.#(REQUIRED): PRIMARY CONTACT: ❑OWNER ❑CONTRACTOR ❑OTHER(Please Specify) CONTACT NAME: CONTACT PHONE: �j' •- _ L j� CONTACT EMAIL: AGREEMENT.1 hereby certify that I have read and examined this application and know the same to be true and correct. All provisionstQH6VIls 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 PERMIT# OwnerlAuthorize a nature Date (Revised 9/23/2016)