806 SE EVERETT MALL WAY 2017-06-20

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 PROJECT SITE INFORMATION �_[� p j1 PROJECT ADDRESS: �� I C;W,-f 1T QO Z bU 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 WOR . $ IC,'6e' NUMBER OF DEVICES (if low oltage): FIRE ALARM? ❑ YES N ASSOCIATED BUILDING PERMI ' applicable): DESCRIPTION OF WORK: i S CGV1 QIJV ,11COl/I /l 404C CIOM1947nkl f l . /ZGf/?f o1- CONTACT INFORMATION OWNER NAME: TENANT NAME(If Commercial): OWNER MAILING ADDRESS: STREET CITY Sl A 11 ZIP OWNER PHONE: / OWNER EMAIL: CONTRACTOR NAME: 0 PC�TYJ C CONTRACTOR ADDRESS: STREET 3Z T- G611 ` S ZCITY 1w/ STATE VV 4 ZIP CONTRACTOR PHONE: Z S,T_ /3)'.2-/qO W- CONTRACTOR EMAIL: Men e"-r- CONTRACTOR CONTRACTOR LIC.#(REQUIRED): Elf 0Ls CIV C-71 (a'6 {%o' CITY OF EVERETT BUSINESS LIC.#(REQUIRED : v�`761� PRIMARY CONTACT: ❑ OWNER ONTRACTOR ❑ OTHER(Please Specify) CONTACT NAME: cad, 't-vys�r' CONTACT PHONE: CONTACT EMAIL: r^ .a AGREEMENT.I hereby certify that I have read and examined this application and know the same to be true and correct. All 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 I comply with the State Contractors Law 18.27 RCW and 296.200 WAC. City of Everett Oficial Use Only - -�— PERMIT# E )S - � 0q Owner o ' ent Signature Date (Revised 9/23/2016)