4128 RUCKER AVE SAFEWAY FUEL STATION 2017-08-24

May 30 17 11:29a Bob Jack • 96746777 p.2 ELECTRICAL PERMIT APPLICATION 4Z77 CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET, EVERETT, WA 98201 (P)425-257-8810 J FAX 425-257-8857 1 (E)everetteps@everettwa.gov I www.everettwa.gov/permits PROJECT SITE INFORMATION PROJECT ADDRESS: ! i BUILDING AREA(if residential,new construction, remodel,or addition) SF BUILDING TYPE: ❑ SFR-DETACHED ❑ SFR-ATTACHED ❑ DUPLEX ❑ MULTI-FAMILY-##OF UNITS: MMERCIAL USE OF BUILDING: + 1 ELECTRICAL APPLICATION INFORMATION CONTRACT PRICE OF WORK: $ NUMBER OF DEVICES if low voltage): FIRE ALARM? ❑YES ONO ASSOCIATED BUILDING PERMIT# if_applicable): DESCRIPTION OF WORK: CONTACT INFORMATION OWNER NAME: 1114`' _ TENANT NAME H Commercial): OWNER MAILING ADDRESS: sTREE-r Cm /t' �f srnm t: l�f ZIP OWNER PHONE: OWNER EMAIL: CONTRACTOR NAME: f \rk —� l.cJ (r) _ r CONTRACTOR ADDRESS: STRE-�r L A crrY U �i Gr sTnTE , 1^ zp C• CONTRACTOR PHONE: J .0. CONTRACTOR EMAIL: CONTRACTOR LIC.#(REQUIRED): CITY OF EVERETT BUSINESS LIC.#(REQUIRED): PRIMARY CONTACT: ❑OWNER `CONTRACTOR ❑ OTHER(Please Specify) CONTACT NANIE�.. CONTACT PHONE. -L _ - J iI\ _f s E� CONTACT EMAIL: :� �� 't; � (i� `�✓\ AGREEMENT.t hereby certify that t have read and examined this application and know the same to be true and corn L All provisions of laws and ordinances goveming this type of work will be completed whetherspectried herein or noL The granting of a permit does 10tpr8sume to give authority to violate or cancel the provisions ofanyotherstala or local Jaw regulating construction or the performance of conatruciion. That f am aufhonzed by the owner of this property to perform the work for which appwcation is made and 1 comply with the State Contra clors Law 78.27 RCW and 296.200 WAC. City of Everett ficial Use Only PERMIT 1f EIj0�, - Cwner/Authorized`Agent Signature / Date (Revised 9/23/2016)