3003 W CASINO RD BLDG 45-12 2018-09-20

ELECTRICAL PERMIT APPLICATION CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET, EVERETT, WA 98201 (P)425-257-8810 � FAX 425-257-8857 � (E)everetteps@everetfinra.gov� www.everettwa.gov/permits r �_ _�. .. - PROJECT SITE INFORMATION ' PROJECT ADDRESS: � Q� �y� � �Q '� v� BUILDING AREA(if residential, new construction, remodel,or addition) SF BUILDING TYPE: ❑SFR-DETACHED ❑SFR-ATTACHED ❑ DUPLEX ❑ MULTI-FAMILY-#OF UNITS: l5'c;UMMERCIAL USE OF BUILDING: �L �� ELECTRICAL APPLICATION INFORMATION' ' CONTRACT PRICE OF WORK: $ � �U� NUMBER OF DEVICES if low voltage): FIRE ALARM? ❑YES �O ASSOCIATED BUILDING PERMIT#(if applicable): DESCRIPTION OF WORK: �p � �3 �p G'6-c.�yt ; CONTACT INFORMATION OWNER NAME: TENANT NAME(If Commercial): OWNER MAILING ADDRESS: sTReer CITY STATE ZIP OWNER PHONE: OWNER EMAIL: CONTRACTOR NAME: �L Ci CONTRACTOR ADDRESS: srReeT �� C�G CITY fj(/ STATE �ij�� ZIP '� /� CONTRACTOR PHONE (j CONTRACTOR EMAIL:�Jp(-n �/' � �p� CONTRACTOR LIC.#(REQUIRED): CITY OF EVERETT BUSINESS LIC.#(REQUIRED):(,o ��U' PRIMARY CONTACT: ❑OWNER CONTRACTOR ❑OTHER(Please Specify) CON CT NAME: CONTACT PHONE: �G� � �' ` �� CONTACT EMAIL: � �"��L AGREEMENT.�I ereby certify that 1 have read and examined this application and know the same to be true and correct All provisions of/aws 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 /oca/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 I comply with the State Contractors Law 18.27 RCW and 296.200 W,4C. City of Everett Official Use Only PERMIT# ,�� 2 E � b - �2'� Owner/Authorized Agent Signature D e (Revised 9/23/2016)