910 SE EVERETT MALL WAY H AND R BLOCK 2019-10-08

RECTRICAL PERMIT APPLICATION CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET, EVERETT, WA 98201 (P)425-257-8810 1 FAX 425-257-8857 ( (E) everetteps@everettwa.gov I www.everettwa.gov/permits PROJECT SITE INFORMATION PROJECT ADDRESS: eV6 c le ` r2 ,�*� U P' 6J_ BUILDING AREA(if residential, new construction, remodel,or addition)_ K3 SF6EQrC (nfi�j✓, - �, BUILDING TYPE: ❑ SFR-DETACHED ❑ SFR-ATTACHED ❑ DUPLEX ❑ MULTI-FAMILY-#OF UNITS: RCOMMERCIAL USE OF BUILDING: ELECTRICAL APPLICATION INFORMATION CONTRACT PRICE OF WORK: $ NUMBER OF DEVICES (if low voltage): FIRE ALARM? ❑YES ❑ NO ASSOCIATED BUILDING PERMIT#(if applicable): DESCRIPTION OF WORK: _IQ, Z �;-� ;3 t e-_ t -5 CONTACT INFORMATION OWNER NAME: *A A C146 17r-j—L LC_ TENANT NAME If Commercial): OWNER MAILING ADDRESS: STREET PL Lax CITY ''�'�- C,( STATE ZIP t` OWNER PHONE: OWNER EMAIL: CONTRACTOR NAME: 11e1AT [ 1-e- CONTRACTOR ADDRESS: STREET ( -�- "�U 61-jV CITY r- �2 �� STATE ZIP CONTRACTOR PHONE: CONTRACTOR EMAIL: LItCGz 4P,5 CONTRACTOR LIC.#(REQUIRED): ~w- ! IS'r I CITY OF EVERETT BUSINESS LIC.#(REQUIRED)G% PRIMARY CONTACT: ❑OWNER ®'CONTRACTOR ❑OTHER(Please Specify) CONTACT NAME: CONTACT PHONE: /c/�'��IIL / l ej�,(JLt j�L CONTACT EMAIL: 41fa e PCGe' lelC Ztr�L �Lt'ill�!"[ L�� AGREEMENT:I hereby certify that I have read and examined this application and know the same to be true and correct. A t 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/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 PERMIT# E DS2 Ownerl uthorized Agent Si ture Date (Revised 9/23/2016) 1