916 PACIFIC AVE BASE FILE 2017-10-30

i ELECTRICAL PERMIAPPLICAT'I®IV 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 1 www.e\ferettvva.gov/permits PROJECT SITE INFORMATION PROJECT ADDRESS: 14 qG vc-r -++ BUILDING AREA(if residential, new construction, remodel,or addition) SF [US ILDING TYPE: ❑ SFR-DETACHED ❑SFR-ATTACHED ❑DUPLEX ❑ MULTI-FAMILY-#OF UNITS: OMMERCIAL E OF BUILDING: ELECTRICAL APPLICATION INFORMATION CONTRACT PRICE OF WORK: $ Sbc).- NUMBER OF DEVICES (if low voltage): FIRE ALARM? ❑YES ❑ NO ASSOCIATED BUILDING PERMIT#(if applicable): DESCRIPTION OF WORK: L _dock to... 2 CONTACT INFORMATION OWNER NAME: TENANT NAME(If Commercial): OWNER MAILING ADDRESS: STREET crry STATE JSP OWNER PHONE: OWNER EMAIL: CONTRACTOR NAME: VtCA E( tM („ CONTRACTOR ADDRESS: STREET ( V 'AL11 3- q CIN L STATE (R1 ZIP 1 (t CONTRACTOR PHONE: 2Gj,--g3d,•j 2ZC CONTRACTOR EMAIL: CONTRACTOR LIC.#(REQUIRED) v cCA tC 5'#Z Yti QCITY OF EVERETT BUSINESS LIC.#(REQUIRED):OOL49 4 S_ CONTRACTOR ❑OTHER PRIMARY CONTACT: El OWNER ........ ... ..:... .. ....,. -- (Please Specify) CONTACT NAME: CONTACT PHONE: ZOO_ S 1✓ &41 CONTACT EMAIL: AGREEMENT.-T hereby certify that 1 have,mad 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/ comply with the State Contractors taw 18.27 RCW and 296.200 WAC. City of Everett Oficial Use Only FEE PERMIT# E I�lb2- b 15 ner/Authorize Agent Signature Da (Revised 10/12/2015)