1717 13TH ST FLOOR 1 MEDICAL CENTER 2021-09-08

-ECTRICAL PERMIT AF ,ICATI®N CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET, EVERETT, WA 98201 (P)425-257-8810 1 FAX 425-257-8857 j (E) everetteps@everettwa.gov I WWW.everettwa.gov/permits PROJECT SITE INFORMATION PROJECT ADDRESS: I�j� I, l' 1= ue r L'f - fti BUILDING AREA(if residential, new construction, remodel, or addition) OF L LDING TYPE: 11 SFR-DETACHED ❑SFR-ATTACHED ❑ DUPLEX ❑ MULTI-FAMILY-#OF UNITS: ❑COMMERCIAL E OF BUILDING: ELECTRICAL APPLICATION INFORMATION CONTRACT PRICE OF WORK: $ �Zp�j NUMBER OF DEVICES (if low voltage): FIRE ALARM? ❑YES ❑ NO ASSOCIATED BUILDING PERMIT#(if applicable): DESCRIPTION OF WORK: J (4e CS CONTACT INFORMATION OWNER NAME: ;g�74, TENANT NAME(If Commercial): OWNER MAILING ADDRESS: STREET crY STATE Z'P OWNER PHONE: OWNER EMAIL: CONTRACTOR NAME: VECA E(e ((_ r L CONTRACTOR ADDRESS: STREET CITY T't-lt. STATE j&) ZiP GlE%1t3� CONTRACTOR PHONE: 'ZrJ(G -�fij(;y• j ZOQ CONTRACTOR EMAIL: CONTRACTOR LIC #(REQUIRED) v EC. cic_z `f Z- CITY OF EVERETT BUSINESS LIC.#(REQUIRED):t�t>�F 4 S (_ - RIMARY CONTACT: ❑OWNER �—�{ - isyCONTRACTOR C7 OTHER Please Specify) CONTACT NAME: CONTACT PHONE: ZtL �) CONTACT EMAIL: AGREEMENT,Thereby certify that I have,vad and examined this application and know the same to be true and correct. All provisions of laws and ordinances goveming 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 cacl the provisions of any otter state or comply with the State Contractors Law 18.27 RCW and 296.200 WAC. locallaw regulating construction or the performance of construction. That/am authorized by the owner of this properly to perform ne the vrork for which application is made and I City of Everett Official Use Only FEE PERMIT# 3L E O er/Authorize Agent Signature Dat�e� nOl L .[D (Revised 10/12/2015)