8811 AIRPORT RD KASCH PARK FUEL ISLAND 2016-08-17

RECTRICAL PERMIT APACATION CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET, EVERETT, WA 98201 (P)425-257-8810 1 FAX 425-257-8857 1 (E) everetteps@everettwa.gov I www.everettwa.gov/permits 13 g ( PROJECT SITE INFORMATION PROJECT ADDRESS: }' (+ G 5 C✓V� C< T� BUILDING AREA(if residential, new construction,remodel,or addition) SF BUILDING TYPE: ❑ SFR-DETACHED ❑ SFR-ATTACHED ❑ DUPLEX ❑ MULTI-FAMILY-#OF UNITS: COMMERCIAL USE OF BUILDING: ELECTRICAL APPLICATION INFORMATION CONTRACT PRICE OF WORK: $ Z 4qo NUMBER OF DEVICES (if low voltage): FIRE ALARM? ❑YES JAO ASSOCIATED BUILDING PERMIT#(if applicable): DESCRIPTION OF WORK: a kA -Q515K' SCS' Cxk CONTACT INFORMATION OWNER NAME: L �_ C36 TENANT NAME(If Commercial): yy�p t- \cL pIV�S�S�I OWNER MAILING ADDRESS: STREET QC�� 16c5 Z CITY LJ\ e STATE ZIP q,%z , OWNER PHONE:+~ j OWNER EMAIL: CONTRACTOR NAME: EQ6'v`c Y\ CONTRACTOR ADDRESS: STREET CITY Ce STATE zl CONTRACTOR PHONE:'4 " CONTRACTOR EMAIL: ` ' ho com ` CONTRACTOR LIC.#(REQUIRED): CITY OF EVERETT BUSINESS LIC.#(REQUIRED): '6L-!b7 PRIMARY CONTACT: ❑OWNER 'CONTRACTOR ❑OTHER(Please Specify) CONTACT NAME: CONTACT PHONE: �a�� ``'1QV�e�ch CONTACT EMAIL: AGREEMENT:T hereby certify that I have read and examined this application and know the same to be true and correct. 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 t am authorized by the owner of this property to perform the work for which application is made and 1 comply with the State Contractors Law 18.27 RCW and 296.200 WAC. City of Everett Official Use Only FEE I 1'5-- 7() PERMJIT# r E l 06-7 l N70 Owr.th.flzed Age' ignature Date (Revised 10/1212015)