916 PACIFIC AVE BASE FILE 2017-10-30

ELECTRICAL PERMIT A#LICATION 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 wtiw,r.everettoia.gov/permiis PROJECT SITE INFORMATION PROJECT ADDRESSAI�cz(�i , r✓ Avt 'F Ue rti I.)A 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: $ I 1 NUMBER OF DEVICES (if low voltage): , FIRE ALARM? ❑YES ❑ NO ASSOCIATED BUILDING PERMIT#(if applicable}: DESCRIPTION OF WORK: }C' L4wV CONTACT INFORMATION OWNER NAME: Ff c v,ULA C__ 1 TENANT NAME If Commerctaq: OWNER MAILING ADDRESS: s-REE, cam [CCOO NER PHONE: OWNER EMAIL; q7 Is TRACTOR NAME: TRACTORADDRESS: STREET ( crrY ( STATE (Il/ 21D v CONTRACTOR PHONE: '2t4-4(3(p•a 2pQ CONTRACTOR EMAIL: CONTRACTOR LIC.#(REQUIRED);V`c(,A rr S 2 AN CITY OF EVERETT BUSINESS LIC.#(REQUIRED):00L64 S" PRIMARY CONTACT: ❑OWNER `'CONTRACTOR 0 OTHER(Please Specify) CONTACT NAME: CONTACT PHONE: CONTACT EMAIL. (( ��^^ A-REEMENT.. T hereb ce at ..�C t4t� y rtify fn_,!have read and examined this application and know the same to be true and correct All provisions of laws and o dinances goveming t ris type of work will be completed whether ,specified herein or not The granting of a permit does rot presume to give authority to violate or cancel the provisions of any other stat_=or local low regulating construction or the parfcm ante of construction. That I am authorized by the owner of this proper f to perform the work for which application is made and/ comply with the State Contractors Law 18.27 RCW and 296.200 WAC. Grty of Everett Official Use Only FEE """"' 7 PERMIT# >oWlAuthorize.rize gent Signature D2<6 (Revised 10/12/2015)