5209 EVERGREEN WAY GROCERY OUTLET 2020-05-08

OLT ELECTRICAL PERMIT APPLICATION 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 www.everettwa.gov/permits PROJECT INFORMATION SITE • • .,. . ..:,.. . . . • PROJECT ADDRESS: Z,( 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: Juj • ELECTRICAI.APPLICATION INFORMATION CONTRACT PRICE OF WORK: $ ' NUMBER OF DEVICES(if low voltage): FIRE ALARM? 0 YES ='i NO ASSOCIATED BUILDING PERMIT#(if applicable): DESCRIPTION OF WORK: 1.{"1-j Ck i f- C" tcrtnneS L / r\ f n)- :CONTACT INFORMATION. OWNER NAME. . `-laZc (a TENANT NAME(If Commercial):46 y Cte�(,Q OWNER MAILING ADDRESS: STREET-7,Q I l 1(.l,f i C� `r ZI cnY pc STATE f ZIP 9(J ( 1 OWNER PHONE: OWNER EMAIL: CONTRACTOR NAME: ' n 1 h C_ CONTRACTOR ADDRESS: STREET/ CnYSl f, 'C�(lrN STATE t,/�\ ZIP 5 C y CONTRACTOR PHONE: )' tl��/ 134' IJ !CONTRACTOR EMAIL: @ckkQ- f;c - CONTRACTOR LIC.#(REQUIRED):C-461\jPj CITY OF EVERETT BUSINESS LIC.#(REQUIRED):e f 121cJ PRIMARY CONTACT: ❑OWNER CONTRACTOR 0 OTHER(Please Specify) CONTACT NAME: CONTACT PHONE: 3(.4)/ s '7 I /3(4_5 CONTACT EMAIL: j- c 5�n t ug 1 AGREEMENT:I hereby certify that I have read and examined this application and know the same to be true and correct. All provisions of[Ks ano 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 I am authorized by the owner of this property to perform the work for which application is made and! comply with the State Contractors Law 18.27 RCW and 296.200 WAC. City of Everett Official Use Only PERMIT# A - (c E t?)04 oco J . > r� • er/Autho ized Age ignature Date (Revised 9/23/2016)