9629 EVERGREEN WAY BASE FILE 2017-11-28

44-77 ELEITRICAL PERMIT APPLIOATION CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET, EVERETT, WA 98201 (P) 425-257-8810 I FAX 425-257-8857 1 (E) everetteps@everettwa.gov I www.everettwa.gov/permits PROJECT SITE INFORMATION PROJECT ADDRESS: *j.C1 4 V L 12( L� a/1 .3;.)/ �ig-`� ,_ ,4 ` 7CI:'�J• 6/11A 11. BUILDING AREA(if residential, new construction, remodel, or addition) SF BUILDING TYPE: 0 SFR-DETACHED 0 SFR-ATTACHED 0 DUPLEX ❑ MULTI-FAMILY-#OF UNITS: ircOMMERCIAL USE OF BUILDING: /4-MIL-- ELECTRICAL ? l(-fesELECTRICAL APPLICATION INFORMATION CONTRACT PRICE OF WORK: $ /5JUC; 1,5 NUMBER OF DEVICES (if low voltage): FIRE ALARM? ❑ YES J10 ASSOCIATED BUILDING PERMIT#(if applicable): ' /60 11—LII( ? DESCRIPTION OF WORK: C - 4 ) C%P e 6k1/ /:fJ C3NPC.? CONTACT INFORMATION OWNER NAME: 4- /.)ff i- %/�J TENANT NAME(If Commercial): OWNER MAILING ADDRESS: STREET )001 ,/ - t>j j2 ' CITY f�i1'I0/0,12s STATE 14/4- ZIP 9r3 L) � OWNER PHONE: OWNER EMAIL: CONTRACTOR NAME: (.91:-L-- 6 t//// c.- CONTRACTOR ADDRESS: STREET /7,-; a I Z }D 7A,1/6„,/" W cy CITY cOA- �7 STATE (�i� ) ZIP ] e � CONTRACTOR PHONE: Lt`s 9r /c iCONTRACTOR EMAIL:-`J `.+ ''K CONTRACTOR LIC.#(REQUIRED): �"�' `5� ) /✓ CITY OF EVERETT BUSINESS LIC.#(REQUIRED): ('g,)). 1)Lig PRIMARY CONTACT: ❑ OWNER XCONTRACTOR 0 OTHER(Please Specify) CONTACT NAME: CONTACT PHONE: //15- C? Cf ,_ 7 r4'ic,1� V/1 �'` r'si ' ry 11 ��(�j�,� ! CONTACT EMAIL: � � � �j-�j^� Cj �,.�y AGREEMENT:T 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 t 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 FEE %-1 PERMIT# 47dd E ISL Owner/Authorized Agent Signature Date (Revised 10/12/2015)