12902 19TH AVE SE ORANGE THEORY 2017-03-09

4err ELECTRICAL PERMIT APOPICATION 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 I www.everettwa.gov/permits 1 PROJECT SITE INFORMATION PROJECT ADDRESS: I2`?O2 I(1-f-t, A1.e .51_: - BUILDING AREA(if residential, new construction, remodel, or addition) SF BUILDING TYPE: ❑ SFR-DETACHED ❑ SFR-ATTACHED ❑ DUPLEX 0 MULTI-FAMILY-#OF UNITS: XCOMMERCIAL USE OF BUILDING: N tci 1\1,-\ CM) ELECTRICAL APPLICATION INFORMATION CONTRACT PRICE OF WORK: $ 3( NUMBER OF DEVICES (if low voltage): :3 FIRE ALARM? ❑YES X.NO ASSOCIATED BUILDING PERMIT#(if applicable): 3 DESCRIPTION OF WORK: T\�lct `` '�'i IAeym0.,)4-a A'`. CONTACT INFORMATION OWNER NAME: Lee iticr144 Ives I -I-Zive0iney1 :Mc .� TENANT NAME(If Commercial): (( U' &t'r-t r I 1 c�i Tr"1t3) OWNER MAILING ADDRESS: STREET ?((.� 6%x9`cl 7 CITY 5i1 QC�'uc.�tt\\L' STATE L)r i ZIP c/h07c'�/ 1 OWNER PHONE: ( OWNER EMAIL: CONTRACTOR NAME: C FM !-1 eicti.i' CU C . A C) CONTRACTOR ADDRESS: STREET ft) 15c j( 3 Z C CITY K ; U- k., clue STATE ' ZIP 76063 063 CONTRACTOR PHONE: '/2:5- i 21- IZ`(,.3 CONTRACTOR EMAIL: J ere 01y C'HONE: N U to(R.. C,--,L1 CONTRACTOR LIC.#(REQUIRED): CrM H C i-Ivi/i 5 3QT CITY OF EVERETT BUSINESS LIC.#(REQUIRED):0115 5 3 7 PRIMARY CONTACT: 0 OWNER ($[CONTRACTOR 0 OTHER(Please Specify) CONTACT NAME: I CONTACT PHONE: ` 2. -WI—f 3 1—€.;clifky )k -1 P( CONTACT EMAIL: JQ-ifZle(-7pm-/4 1cr Ca' '1 AGREEMENT:T hereby certify that I have read and examined this application and know the same to be true land 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 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 WAC. City of Everett Official Use Only FEE hi•r,y (, • PERMIT# Ci Owner/ uthoriz dJjent Signature Date (Revised 10/12/2015)