6623 EVERGREEN WAY UNION BANK 2018-10-12

EL:TRICAL PERMIT APPL ATION CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET, EVERETT, WA 98201 (P)425-257-8810 ` FAX 425-257-8857 1 (E)everetteps@everettwa.gov www.everettwa.gov/permits PROJECT SITE--iNFO,RMATION PROJECT ADDRESS: BUILDING AREA(If residential, new construction, re odel,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: $ - o-, l� NUMBER OF DEVICES (if low volta e): FIRE ALARM? ❑YES NO ASSOCIATED BUILDING PERMIT#(if a licable): DESCRIPTION OF WORK: G / CONTACT'INFORMATION OWNER NAME: �V (/L?�L G,, TENANT NAME(If Com mer cial): OWNER MAILING ADDRESS: STREETS r CITY STATE ZIP OWNER PHONE: OWNER EMAIL: CONTRACTOR NAME: CONTRACTOR ADDRESS: STREET Q��=C (7"11' � ✓( CITY SLATE yZIP CONTRACTOR PHON . Gy (� J CONTRACTOR EMAIL: CONTRACTOR LIC.#(REQUIRED): CITY OF EVERETT BUSINESS C.#(REQUIRED): PRIMARY CONTACT: ❑ OWNERCONTRACTOR ❑OTHER(Please Specify) CONTACT NAME: CONTACT PHONE: pvcw (% CONTACT EMAIL: AGREEMENT:T her4y certify that I have read and examined this application and know the same to be true and correct. All provisio '_ 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 - focal law regulating construction or the performance of construction. That I am authorized by the owner of thls property to perform the work for which application is made and I I comply with the State Contractors Law 98.27 RCW and 296.200 WAC. City of Everett Official Use Only FEE 4 �)oo PERMIT# E U2,- �� I Owner/Authorized AUIAt Signature Date (Revised 10/9712095)