4205 RIVERFRONT BLVD COE LIFT STATION #42 2018-03-27

�ECTRICAL PERMIT AP�ICATION CITY OF EVERETT PERMIT SERVICES 32Q0 CEDAR STREET, EVERETT, WA 98201 (P) 425-257-8810 � FAX 425-257-8857 � (E} everetteps�a everettwa.gov� www.everettwa.gov/permits PR�JECT SITE tNFORMATION �J- � , PROJECT ADDRESS: �C�� /C./�.�_ . ' � ' � ;%Y ,�� BUILDING AREA(if residential,new construciion,remodel,or addition) SF BUILDING TYPE: ❑ SFR-DETACHED ❑SFR-ATTACHED ❑ DUPLEX ❑MULTI-FAMILY-#QF UNITS: �COMMERCIAL USE OF BUILDING: �,,,� �(�� ELECTRICAL APPLICATION INFORMATION CONTRACT PRICE OF WORK: $ �� "�Q(� NUMBER OF DEVICES (if law volta e): FIRE ALARM? ❑YES NO ASSOGIATED BUILDtNG PERMIT# if a plicable): DESCRIPTI�N OF WORK: �„{ t�"c.�tt�Y'1 , _�[ �' '"�'�` �� Z ___ _ � ,,� GONTAGT tNFI�RMATION OWNER tJAME: TEIVANT NAME(If Commercial): OWNER MAILING ADDRESS: srReEr � CITY STATE ZIP � OWNER PHONE: h� OWNER EMAIL: CONTRACTOR NAME: ��J � CONTRACTOR ADDRESS: srReEr C�Ty STATE ZIP CONTRACTOR PHONE: � �— CON7RACTOR EMAIL: CONTRACTOR LIC.#{REQUIRED): � �IA CITY OF EVERETT BUSINESS LIC.#(REQUIRED):� PRIMARY CONTACT: ❑OWNER .�,CONTRACTQR ❑OTHER(Please Specify) CONTACT NAME: CONTACT PHONE: l..��1.1 g�,,,. � ��.- L(�f''.Q,� �� CONTAGT ENIAIL• � AGREEMENT.•T hereby ca�tity that J have read and examined fhis appfication and know the same to be true and co ecL AI!provisions of laws and ordinances governing this type of wotk wilt ke completed whether specifred herein ornot. The granting of a permit does naf presume to grve authprity to violafe or cancel the provisions of any other state or locai law regulating consfruction or the performance of constructio». That I am authorized by fhe owner of this property fa perform the work for which appNcatian is made and/ comply with the Sfate Contractors Law 18.27 RCW and 296.200 WAC. . Cify of Everett OHiciat Use Only FE E �, �U 5o DO. PERMIT# �� .-� �:��..�� '� E I �.�D�� Q�l� i3wner/Authorized Agent Signature Date (Revised 10/12/20i5)