10200 19TH AVE SE COSTCO FOOD COURT 2017-03-13

F CTRICAL PERMIT AP;CATION CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET, EVERETT, WA 98201 (P) 425-257-8810 I FAX 425-257-8857 I (E) everetteps@everettwa.gov www.everettwa.gov/permits PROJECT SITE INFORMATION PROJECT ADDRESS: % )2C. w � �� °r BUILDING AREA(if residential, new construction,remodel,or addition) SF BUILDING TYPE: 0 SFR-DETACHED 0 SFR-ATTAC H E D 0 DUPLEX 0 MULTI-FAMILY-#OF UNITS: COMMERCIAL USE OF BUILDING: ( _ ..)\`C,..(S) ELECTRICAL APPLICATION INFORMATION CONTRACT PRICE OF WORK: $ <7'17� :I ' ` NUMBER OF DEVICES (if low voltage): FIRE ALARM? 0 YES 0 NO ASSOCIATED BUILDING PERMIT# (if applicable): DESCRIPTION OF((WWORK: j: <;) ,{\ CONTACT INFORMATION OWNER NAME: r ,'« , C TENANT NAME(If Commercial): '....,' OWNER MAILING ADDRESS: STREET 1,C2:2-4-12L>. .( 1- _i ` .6E- I STATE LANA zip i<4.14°.:, crrY t= ...ts... OWNER PHONE: OWNER EMAIL: CONTRACTOR NAME: M F CC) CONTRACTOR ADDRESS: STREET �m S) "� , � � . CITY STATE(..-"�...�j.... ZIP IL) ...t'•k.� CONTRACTOR PHON - CONTRACTOR EMAIL: -'"S.-'-r�... '` : CONTRACTOR LIC.#(REQUIRED): CITY OF EVERETT BUSINESS LIC.#(REQUIRED):t-`..0.2 t4I PRIMARY CONTACT: 0 OWNER pONTRACTOR 0 OTHER(Please Specify) CONTACT NAME CONTACT PHONE: ' � . ) rr �- 1 CONTACT EMAIL: d ,. f r ' I xr AGREEMENT:T hereby certify that I have read and examined this application and know the same to be true and correct All proms 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 I 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 296.200 WA C City of Everett Official Use Only FEE 2 .�� 121 PERMIT# --- , - IL 4) E I to() I- \�C� w g Signature A gent Si nature Date (Revised 10/12/2015)