1205 CRAFTSMAN WAY SLIP 23 DOCK I 2021-12-06

• tLECTRICAL 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 PROJECT ADDRESS: IdOI5 r\Qw 17 SL) PA 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 WORK: $ aoo NUMBER OF DEVICES (if low voltage): FIRE ALARM? ❑YES ItNO ASSOCIATED BUILDING PERMIT# (if applicable): DESCRIPTION OF WORK: / c CONTACT INFORMATION OWNER NAME: ./j out TENANT NAME(If Commercial): OWNER MAILING ADDRESS: STREET a G CIN �,J�• STATEPA ZIP OWNER PHONE: 3 ` 104q OWN.}ER EMAIL: CONTRACTOR NAME: V CONTRACTOR ADDRESS: STREET Q l b CITY rSTATE ZIP D CONTRACTOR PHONE: CONTRACTOR EMAIL: CONTRACTOR LIC.#(REQUIRED): CITY OF EVERETT BUSINESS LIC.#(REQUIRED): cam PRIMARY CONTACT: ❑OWNER &LONTRACTOR ❑ OTHER(Please Specify) CONTACT NAME: CONTACT PHONE: '��V. ,A 1-1,1 CONTACT EMAIL: AGREEMENT.Thereby certify that I have read and examined this application and know the same to be true and correct. All provisi ns 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. Cityof Everett Official Use Only FEE 4 I 0� r�_D PERMIT# Own uthorize gent ignature Dae (Revised 10/12/2015)