10220 EVERGREEN WAY CHEVRON 2017-05-23

EECTRICAL PERMIT APP "ATION CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET, EVERETT, WA 98201 (P)425-257-8810 1 FAX 425-257-8857 1 (E)everetteps@everettwa.gov I www.everettwa.gov/permits PROJECT SITE INFORMATION PROJECT ADDRESS: BUILDING AREA(if residential,new construction,remodel,or addition) SF BUILDING TYPE: ❑SFR-DETACHED ❑SFR-ATTACHED ❑ DUPLEX ❑ MULTI-FAMILY-#OF UNITS: .2'60MMERCIAL USE OF BUILDING: ELECTRICAL APPLICATION INFORMATION CONTRACT PRICE OF WORK: $ ; - , NUMBER OF DEVICES if low voltage): FIRE ALARM? ❑YES ❑NO ASSOCIATED BUILDING PERMIT# if applicable): G t / DESCRIPTION OF WORK: ✓ly V W � CONTACT INFORMATION OWNER NAME: 1 A kA Ll TENANT NAME(If Commercial): C7j_1 t//rf Mk& OWNER MAILING ADDRESS: STREET (3 Gr CITY STATE j1t ZIP Wzev OWNER PHONE:0Z0 ! S9 A513 1OWNER EMAIL: CONTRACTOR NAME: jVk[ 1 CONTRACTOR ADDRESS: STREET "U� CRYey1flW STATE ZIP CONTRACTOR PHONE: X_ Jd � jpCONTRACTOR EMAIL: JJ CONTRACTOR LIC.#(REQUIRED): L- X1,01 7��-/" CITY OF EVERETT BUSINESS LIC.#(REQUIRED)V/6 jG PRIMARY CONTACT: ❑OWNER ❑CONTRACTOR ❑OTHER(Please Specify) CONTACT NAME: [C=0NTAEMAIL: ONTACT PHONE: 1 lL�,li,I AGREEMENT:I hereby certify that I have read and examined this application and know the same to be true and 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 PERMIT# y/'2 E /7"r/Authorized Agent Signature Date (Revised 9/23/2016)