515 SE EVERETT MALL WAY CHIPOTLE 2017-05-03

Sep 26 16 09:02a Rory Villa 360-653-4544 p.1 MLECTRICAL PERMIT APPLICATION CITY OF EVERETT PERMIT SERVICES OL 3200 CEDAR STREET, EVERETT,WA 98201 (P)425-257-8810 J FAX 425-257-8857 ( (E)everetteps@everettwa.gov I www.everettwa.gov/permits PROJECT SITE INFORMATION PROJECT ADDRESS: F If_r ir— V'.'Er, LIZ BUILDING AREA(if residential,new construction,remodel,or addition) SF BUILDING TYPE: ❑SFR-DETACHED ❑SFR-ATTACHED ❑ DUPLEX ❑ MULTI-FAMILY-#OF UNIT'S: COMMERCIAL USE OF BUILDING: ELECTRICAL APPLICATION INFORMATION CONTRACT PRICE OF WORK: $ 5 NUMBER OF DEVICES if low voltage).-_ !e� FIRE ALARM? ❑YES ANO ASSOCIATED BUILDING PERMIT* if.ap licable): DESCRIPTION OF WORK: �' �- ')Q:t S CONTACT INFORMATION OWNER NAME. TENANT NAME(if Commercial):C OWNER MAILING ADDRESS: STREET CITY STATE ZIP OWNER PHONE: OWNER EMAIL: CONTRACTOR NAME: � 4-iO CONTRACTOR ADDRESS: l+ , CITY �V L✓ STATE A— Z CONTRACTOR PHONE: t'o Z CONTRACTOR EMAIL: CONTRACTOR LIC.#(REQUIRED): S CITY OF EVERETT BUSINESS LIC. T-(REQUIRED): D PRIMARY CONTACT: ❑ OWNER 01CONTRACTOR ❑OTHER(Please Specify) CONTACT NAME: CONTACT PHONE: z 3a 3 © G CONTACT EMAIL: f Oft t/J J I C 9 r� AGREEMENT..F herdby certify that I have read and examined this application and know the same to be hue and couect. All pravrsions of laws and ordinances governmg this type of work will be completed whetherspoaf'red herein or not. Tho granting of a permit does notauth Am to msuma p g onty to violate or cancel the provisions of any other state or local law rogulating construction or the performance of const, d bn. That 1 am au"zed by the owner of this property to perform the work for which application is made and t compfy with rho State Contractors Law l B.27 RCW and 296.200 WAC. City of Everett Official Use Only FEE X2 . 00 PERMIT# D E Authorized Agent 5fgnature Date (Revised 1011212015J