515 SE EVERETT MALL WAY CHIPOTLE 2017-05-03

ELECTRICAL PERMIT APPLICATION CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET, EVERETT, WA 98201 (P)425-257-8810 FAX 425-257-8857 J (E)everetteps@everettwa.gov J www.everettwa.gov/permits PRJEiT;SrtTG:11�FdIEt1'`lGN PROJECT ADDRESS: 1 I 4 BUILDING AREA(if residential, new construction, remodel, or addition) SF BUILDING TYPE: ❑ SFR-DETACHED ❑ SFR-ATTACHED ❑ DUPLEX ❑ MULTI-FAMILY-#OF UNITS: JR COMMERCIAL USE OF BUILDING: 1 2 57 'ray,) IC AP -AT CONTRACT PRICE OF WORK: E (p Sv ""1 NUMBER OF DEVICES if low voltage): FIRE ALARM? ❑YES 6 NO ASSOCIATED BUILDING PERMIT# if a iicable : DESCRIPTION OF WORK: .�MT �T tM�i?RM1�lfN OWNER NAME: TENANT NAME(if Commercial): OWNER MAILING ADDRESS: STREET i c Soo ,,^.Ih' STATE Co ZIP OWNER PHONE: ?)o" - (,pU 5 OWNER EMAIL: CONTRACTOR NAME: o i JO , L L CONTRACTOR ADDRESS: STREET r r CITY , STATE •,17/� 2IP r " CONTRACTOR PHONE:, P - CONTRACTOR EMAIL: k L G'h< <_ • (+L'Yt CONTRACTOR LIC.#(REQUIRED): L CITY OF EVERETT BUSINESS LIC.#(REQUIF2EL 65 r 3 PRIMARY CONTACT: ❑OWNER $I CONTRACTOR ❑OTHER(Please Specify) CONTACT NAME: CONTACT PHONE: - J CONTACT EMAIL: t L AGREEMENT.'T herAycetfify that i have read and examined this application and know the same to be true and correct. All provisions of taws 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 yaw 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 Lbw 18.27 RCW and 296.200 WAC. City of Everett Oficial Use Only FEE 501 PERMIT# Owner/Authorized Agent Signature Date (Revised 1011212015)