2615 BROADWAY QFC 2016-08-17 - Laserfiche WebLink

0 0 ELECTRICAL PERMIT APPLICATION CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET, EVERETT, WA 98201 (P)425-257-8810 ( FAX 425-257-8857 1 (E) everetteps@everettwa.gov I www.everettwa.gov/permits PROJECT SITE INFORMATION PROJECT ADDRESS: BUILDING AREA(if residential, new construction,remodel,or addition) SF BUILDING TYPE: 0 SFR-DETACI-IED 0 SFR-ATTACHED 0 DUPLEX ❑MULTI-FAMILY-#OF UNITS: G1.eOMMERCIAL USE OF BUILDING: ELECTRICAL APPLICATION INFORMATION CONTRACT PRICE OF WORK: $ NUMBER OF DEVICES if low voltage): FIRE ALARM? 0 YES 0 NO ASSOCIATED BUILDING PERMIT#(if applicable): DESCRIPTION OF WORK: CONTACT INFORMATION OWNER NAME: TENANT NAME(If Commercial): OWNER MAILING ADDRESS: STREET ,,..2 44:�>C- ra!- Y { CITY 4. STATE l '.. ZIP OWNER PHONE: OWNER EMAIL: CONTRACTOR NAME: CONTRACTOR ADDRESS: STREET l y ; l CITY �'_ STATE "'""...d ZIP CONTRACTOR PHONE: -�' CONTRACTOR EMAIL: CONTRACTOR LIC.#(REQUIRED) CITY OF EVERETT BU INESS Lid.#(REQUIRED): cmc z PRIMARY CONTACT: ❑OWNER CONTRACTOR 0 OTHER(Please Specify) CONTACT,NAME: CONTACT PHONE: CONTACT EMAIL: f T I L i,__-7, AGREEMENT. T hereby certify that t have read and examined this application and know the same to be true and con'ec 11 povisio f 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 taw regulating construction or the performance of construction- That f 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 295.200 WAC. City of Everett Official Use Only FEE PERMIT# -.: Ow orizecTAgent Signature Date (Revised 1011212015)