1402 SE EVERETT MALL WAY SKINNY Ds YOGURT 2018-01-18

�ECTRICAL PERMIT Af�LICATION CITY OF EVERETT PERMIT SERVICES �` �� 3200 CEDAR STREET, EVERETT, WA 98201 (P)425-257-8810 � FAX 425-257-8857 � (E) everetteps@everettwa.gov � wuvw.everettwa.gov/permits PROJECT SITE INFORMATION PROJECT ADDRESS: �, , ..(��- ' �"V BUILDING AREA(if residential,new construction, remodel, or addition) SF BUILDING TYPE: ❑ SFR-DETACHED ❑ SFR-ATTACHED ❑ DUPLEX ❑ MULT�-FAMILY-#OF UNITS: ❑ COMMERCIAL USE OF BUILDING: ELECTRICAL APPLICATION INFORMATION CONTRACT PRICE OF WORK: $ - NUMBER OF DEVICES if low volta e : FIRE ALARM? ❑YES ❑ NO ASSOCIATED BUILDING PERMIT# if applicable : DESCRIPTION OF WORK: � � G i - P �� CONTACT INFORMATION OWNER NAME: ��, S L NANT NAME(If Commercial): OWNER MAILING ADDRESS: sraeer �� ,� � Z ��7y C STATE ZIP � � OWNER PHONE: OWNER EMAIL: CONTRACTOR NAME: ;,l - � CONTRACTOR ADDRESS: s�aeer U � p cm L.�� STATE ZIP �' L CONTRACTOR PHONE: �� '� ' %� CONTRACTOR EMAIL: � CONTRACTOR LIC.#(REQUIRED): ; ��. CITY OF EVERETT BUSINESS LIC.#( EQUIRED): �/ PRIMARY CONTACT: ❑ OWNER ❑ CONTRACTOR ❑OTHER(Please Specify) CONTACT�ME: � CONTACT PHONE: c��,� f �f �e" V� CONTACT EMAIL: ��le x AGREEMENT.•T hereby certify that 1 have read and examined this application and know the same to be true and correct. All provisi ns aws an inances goveming this type of work wil!be completed whether spec�ed 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 regulafing construction or the performance of construction. That 1 am authorized by the owner of this property to perform the work for which applicafion is made and I comply wffh the State Contractors Law 18.27 RCW and 296.200 WAC. City of Everett O�cial Use Only FEE �(,C'C IPERMIT# O l! � E ��%�� l � C�� `� O ' e Authori d Agent Signature Date (Revised 10/12/2015)