6605 MERRILL CREEK PKY 2017-06-22

ELECTRICAL PERMIT APPLICATION CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET, EVERETT, WA 98201 (P)425-257-8810 FAX 425-257-8857 1 (E) everetteps@everettwa.gov I www.everettwa.gov/permits PROJECT.SITE INFORMATION - PROJECT ADDRESS: ,l BUILDING AREA(if residential,new construction, remodel,or addition) (n; s SF BUILDING TYPE: ❑ SFR-DETACHED ❑ SFR-ATTACHED ❑ DUPLEX ❑ MULTI-FAMILY-#OF UNITS: COMMERCIAL USE OF BUILDING: t 1 ELECTRICAL APPLICATION INFORMATION CONTRACT PRICE OF WORK: $ i 1 (-;c' c,U, ' 00 NUMBER OF DEVICES if low voltage): `2l FIRE ALARM? ❑YES NO ASSOCIATED BUILDING PERMIT#(if applicable): C` DESCRIPTION OF WORK: W :- '� C", !1 y i I G CONTACT INFORMATION OWNER NAME: TENANT NAME(If Commercial): OWNER MAILING ADDRESS: STREET L �`l,C(I t 1 1 ( 1{' K PJ i» CITY - �'t' 1 '�. STATE L�� ZIP C1 OWNER PHONE: r7 Cg q 1OWNER EMAIL: ` V `;(Cc'l t CONTRACTOR NAME: CONTRACTOR ADDRESS: STREET ,i'. CIT' l.-rY)�:�,. STALE )A ZIP CONTRACTOR PHONE: -1' 71 CONTRACTOR EMAIL: CONTRACTOR LIC.#(REQUIRED): `�ti t t I�;. `� 1�� '.'�-.I CITY OF EVERETT BUSINESS LIC.#(REQUIRED):c,lq,c1 't PRIMARY CONTACT: ❑ OWNER IVCONTRACTOR ❑ OTHER(Please Specify) CONTACT NAME: CONTACT PHONE: CONTACT EMAIL AGREEMENT/hereby certify that 1 have read and xamined this application and know the same to be true and correct. At provisions of laws and`ordin'ances 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 Official Use Only PEP", Owner/Authorized hgent Signature I Date (Revised 9/2312016)