3802 BROADWAY B WESTERN WA MEDICAL GROUP 2017-01-13

(P) 425-257-8810 E :CTRICAL PERMIT AP ICATION CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET, EVERETT, WA 98201 FAX 425-257-8857 �(E) everetteps@everettwa.gov � www.everettwa.govJpermits PROJECT SITE INFORMATI�N PROJECT ADDRESS: ;� , �v "�.9 ��J%- BUILDING AREA (if residential, new construction, remodel, or addition) ��'�'� SF BUILDING TYPE: ❑ SFR-DETACHED ❑ SFR-ATTACHED ❑ DUPLEX ❑ MULTI-FAMILY -# OF UNITS: L COMMERCIAL USE OF BUILDING: � ;if!Ces ELECTRICAL APPLICATION INFORMATION CONTRACT PRICE OF WORK: $ NUMBER OF DEVICES (if low voltage): FIRE ALARM? ❑ YES G`N0 ASSOCIATED BUILDING PERMIT # (if applicable): DESCRIPTION OF WORK: OWNER NAME: OWNER MAILING ADDRESS OWNER PHONE: STREET CITY CONTRACTOR NAME: � � �� tr � �- � CONTRACTOR ADDRESS: sTR�cr CITY CONTRACTOR PHONE: CONTRACTOR LIC. #(RECIUIRED): CONTACT INFORMATION TENANT NAME (If Commercial): EMAIL: STATE STATE ZIP ZIP CONTRACTOR EMAIL: - CITY OF EVERETT BUSINESS LIC. #(P,EQUIRED): / C ?PRIMARY CONTACT: ❑ OWNER ❑ CONTRACTOR ❑ OTHER (Please Specify) - a J "yONTACT iVAME: CONTACT PHONE: � CONTACT EMAIL: 4GREEMENT: T hereby r,ertify that 1 have read and examined this application and know the same to be true and correct. All provisions of laws and ordinances governing this ;ype of work will be completed whether speciiied herein or not. The granting of a permit does not presurne to give authority lo violate or cancel the provisions of any other state or local law regulating consiruction or the performance ol construction. That I am auihorized by the owner o( this properry to perform the work for which applicatron is made and I comply wi�h the State Contractors Law 1 A.27 RCW and 296.200 WAC. -- _ - ------ :�•.� �.F a�a.�,iL , �c' % ... ;:� ,�s�e Datc City of Everett Official Use On/y FEE ( _-f�� J — _- -- PERMIT # E ��o� - �� � (Rr.visen' 1O r �°0151 -