515 SE EVERETT MALL WAY CHIPOTLE 2017-05-03

i ELECTRICAL PERMIT APPLICATION CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET, EVERETT, WA 98201 (P)425-257-8890 FAX 425-257-8857 j (E) everetteps@everettwa.gov ( www,everettwa.gov/permits PROJECT SITE INFORMATION _ E PROJECT ADDRESS: ( is C Eu6rdf BUILDING AREA(if residential, new construction,remodel,or addition) SF BUILDING TYPE: El SFR-DETACHED ❑SFR-ATTACHED ❑ DUPLEX ❑ MULTI-FAMILY-#OF UNITS: MtOMMERCIAL USE OF BUILDING: ELECTRICAL APPLICATION INFORMATION CONTRACT PRICE OF WORK:$ 13 0 NUMBER OF DEVICES(if low voltage): -ST-5404S FIRE ALARM? ❑YES ©NO ASSOCIATED BUILDING PERMIT#(if applicable): _ DESCRIPTION OF WORK: ; CONTACT INFORMATION I OWNER NAME: ' TENANT NAME(if Commercial): OWNER MAILING ADDRESS: STREET CITY STATE LIP OWNER PHONE: OWNER EMAIL: CONTRACTOR NAME: Mp_�rclC . CONTRACTOR ADDRESS: STREET '* 6gp CITY 16 ir A tclnj STATF Wk. ZIP gy�3r j CONTRACTOR PHONE: 25- 7 CONTRACTOR EMAIL: CONTRACTOR LIC.#(RE4UIRED): CITY OF EVERETT B (NESS LIC,#(REQUIRED): PRIMARY CONTACT: ©OWNER &tbNTRACTOR ©OTHER(Please Specify) I CONTACT NAME: CONTACT PHONE: { CONTACT EMAIL: AGREEMENT:T hereby certify that J 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 law regulating construction or the performance of construction. That t am authorized by the owner of this property to perform the work for which application is made and 1 comply with the State Contractors Law 18.27 RCW and 296.200 WAC. City of Everett Official Use Only FEE �;(D — - PERMIT# I Owner/Authorized Agent Signature Date ` (Revised 10/12/2015) E