1121 SE EVERETT MALL WAY EVERETT POLICE DEPT SOUTH PRECINCT 2019-10-09

ELECTRICAL PERMIT APPLICATION /11111P---"4_ 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: f/ S� iev'er ,/vj a(947 BUILDING AREA(if residential, new construction, remodel,or addition) SF BUILDING TYPE: 0 SFR-DETACHED 0 SFR-ATTACHED 0 DUPLEX 0 MULTI-FAMILY-#OF UNITS: ,'COMMERCIAL USE OF BUILDING: ELECTRICAL APPLICATION INFORMATION CONTRACT PRICE OF WORK: $ , .; a -' -1:)0©© Ov NUMBER OF DEVICES (if low voltage): BOP FIRE ALARM? 0 YES gNO ASSOCIATED BUILDING PERMIT#(if applicable): DESCRIPTION OF WORK: �G.01 / held 81104/.1i-0Y 5. CONTACT INFORMATION OWNER NAME: U ev'eTt ) l PG TENANT NAME(If Commercial): OWNER MAILING ADDRESS: STREET //Z( 5 Lv,favJ Aka k.4' 7� CITY !/tov�I STATE r- yA- ZIP fQ�(/? OWNER PHONE: OWNER EMAIL: CONTRACTOR NAME: hi nit Pe 06e: 47`e CONTRACTOR ADDRESS: STREET 674 5 9 we Q CITY J 7 e1.�1� STATE P144- ZIP "),/Z- 7/ CONTRACTOR PHONE: CONTRACTOR EMAIL: CONTRACTOR LIC.#(REQUIRED): �-ri.�-pIVL 9q 5' k CITY OF EVERETT BUSINESS LIC.#(REQUIRED): /JOy. PRIMARY CONTACT: 0 OWNER CONTRACTOR 0 OTHER(Please Specify) JZoi Jj4 It CONTACT NAME: CONTACT PHONE: i?4,./tka, CONTACT EMAIL: 1 lG4.7 AGREEMENT:I hereby certify that l have read and damined this application and know the same to be true and corre . 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 l 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# OIL! Owner/Authorized Agent Signature ° Date (Revised 9/23/2016)