4919 EVERGREEN WAY QFC 2016-08-04

Boyer Electric Co 2063674575 p,02 • • OLT ELECTRICAL PERMIT APPLICATION CITY OP 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; ` i\y—1 1T::::'V -e-c i ! \C� BUILDING AREA(if residential, naw construction, remode, or addition) SF BUILDING TYPE: ❑ SFR-DETACHED 0 SFR-ATTACHED 0 DUPLEX 0 MULTI-FAMILY-#OF UNITS: ,COMMERCIAL USE OF BUILDING: ELECTRICAL APPLICATION INFORMATION CONTRACT PRICE OF WORK: $ *2-aCr NUMBER OF DEVICES (if low voltage); FIRE ALARM? ❑YES 0 NO ASSOCIATED BUILDING PERMIT# (if applicable): DESCRIPTION OF WORK: .-Th --ii. c :--'s) ,-, 3- CONTACT INFORMATION _.�y OWNER NAME: TENANT NAME(If Commercial): R- OWNER MAILING AODRE$S: aTRccT \ ,Y,.. ~ CITY "'OC.). ' STATEL4 ZIP 1-'LY` *,A OWNER PHONE:p�4- 5 2- b2 OWNER EMAIL: CONTRACTOR NAME: ,I, 1C Jc_ C Cf) -11--. CONTRACTOR ADDRESS: sTctEETa� L , C 7 l -C:4-H. .e STATE 1_,,......Y.-4ZIP Ci-b1: CONTRACTOR PHONE: , ,-r�Rd.. CONTRACTOR EMAIL: _ CONTRACTOR LIC.#(REQUIRED): tSILL�=_ CITY OF EVERETT BUSINESS LIC.it(REQUIRED):Q�tg1 PRIMARY CONTACT: 0 OWNER „I CONTRACTOR 0 OTHER(Please Specify) CONTACT NAME: CONTACT PHONE: ( ) ; j--I s-5 ` I CONTACT EMAIL: �� c ,,,e"" . cis. 1 _ AGREEMENT: T hereby certify the have read and examined this eppiicatlon and know the same to be true and co All pr '". as.of laws and ordinances governing this type of work will be completed whether specified herein or not. The granting of e permit does not presume to give euthority to violate or contel the provisions of any other state or local Ow regulating construction or the performance of construction. That!em authorized by the owner of this property to perform the work for which application Is made end I comply with the State Contractors Law 18,2T RGW and 296.200 WAC, City of Everett Official Use Only FEE ;( II • <2 PER MIT 7Y Owner! thorized t Si nature date (Revised 10/12/2015)