4225 HOYT AVE WESTERN WA MEDICAL GROUP 2017-06-13

EUUTRICAL PERMIT APPL ATION E17 CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET, EVERETT, WA 98201 (P)425-257-8810 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: COMMERCIAL USE OF BUILDING: i i 1,�/ //I f,r �i. t� 1''� 44 ELECTRICAL APPLICATION INFORMATION CONTRACT PRICE OF WORK: $ NUMBER OF DEVICES if low voltage): FIRE ALARM? ❑YES NO ASSOCIATED BUILDING PERMIT# if applicable): DESCRIPTION OF WORK: /,. , •, ...;,, `',: -fCj-�'�.t:, vim'.: x, f' e' t" :� -- I I CONTACT INFORMATION ` i �� if rf��Cc TENANT NAME if Commercial): OWNER NAME: l�/c': l_�• t!�C l' Lkl�,t-Leer 27.2 /9 -._-� -)-- OWNER MAILING ADDRESS: STRE.=T CITY '1-X12-t- STATE I �:"i ZIP 1, OWNER PHONE:'fc s n,,� 'G ` ' OWNER EMAIL: CONTRACTOR NAME: CONTRACTOR ADDRESS., STREET } "� l - CITY r'-sC // STATE /t-1U= ZIP CONTRACTOR PHONE:. } 3z CONTRACTOR EMAIL: CONTRACTOR LIC.#(REQUIRED}: T � tij f t � v['C-� CITY OF EVERETT BUSINESS LIC.#(REQUIRED): PRIMARY CONTACT: ❑ OWNER .,8 CONTRACTOR ❑ OTHER(Please Specify) CONTACT NAME: CONTACT PHONE:; z% t CONTACT EMAIL: f - AGREEMENT:T,11areby certify that I have read and examined this application and know the same to be true and correct. All provisi&s of laws and ordinances goveming 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 constructlon. That t 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 00 PERMIT#r� l Owner/Authorized Agent Signature Date (Revised 10/1212.015)