220 SE EVERETT MALL WAY 2017-06-12

ELECTRICAL PERMIT APPLICATION CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET, EVERETT, WA 98201 (P)425-257-8810 FAX 425-257-8857 (E) everetteps@everettwa.gov www.everettwa.gov/permits PROJECT SITE INFORMATION PROJECT ADDRESS: 7 ) C —V-e Y 1— BUILDING AREA(if residential, new construction, remodel,or addition) SF BUILDING TYPE: ❑ SFR-DETACHED ❑ SFR-ATTACHED ❑ DUPLEX ❑ MULTI-FAMILY-#OF UNITS: OMMERCIAL USE OF BUILDING: ELECTRICAL APPLICATION INFORMATION CONTRACT PRICE OF WORK: $ NUMBER OF DEVICES (if low voltbe): FIRE ALARM? ❑YES ASSOCIATED BUILDING PERMIT#(if applicable): DESCRIPTION OF WORK: r) //11 CONTACT INFORMATION OWNER NAME: V co TENANT NAME(If Commercial): OWNER MAILING ADDRESS: STREET CITY STATE ZIP OWNER PHONE: OWNER EMAIL: CONTRACTOR NAME: YVLC'"- p 1 ► y CONTRACTOR ADDRESS: STREET O? . Z CITY tNC, l Q0 C 1 STATE ZIP CONTRACTOR PHONE: C��j 2' 2Z CONTRACTOR EMAIL: CONTRACTOR LIC.#(REQUIRED): Y"�� ,0S CITY OF EVERETT BUSINESS LIC.#(REQUIR ): PRIMARY CONTACT: ❑OWNER ❑CONTRACTOR DkTHER(Please Specify) CONTACT NAME: CONTACT PHONE: Z — L r CONTACT EMAIL: 7 _ AGREEMENT.Thereby certify that I ave read and examined this application and know the same to be true and correct All provisions oflaws 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 I comply with the State Contractors Law 18.27 RCW and 296.200 WAC. City of Everett Official Use Only FEE 15 --� D PERMIT# O /Authorized Agent nature Date (Revised 10/1212015)