1402 SE EVERETT MALL WAY AMERICAN CROWN CIRCUS 2017-10-18

• • ELECTRICAL PERMIT APPLICATION 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: Everett Mall 1402 SE Everett Way BUILDING AREA(if residential, new construction, remodel, or addition) N/A SF BUILDING TYPE: ❑ SFR-DETACHED ❑ SFR-ATTACHED ❑ DUPLEX ❑ MULTI-FAMILY-#OF UNITS: ❑ COMMERCIAL USE OF BUILDING: NSA ELECTRICAL APPLICATION INFORMATION CONTRACT PRICE OF WORK: $ 1,000.00 NUMBER OF DEVICES (if low voltage): 1 FIRE ALARM? ❑YES IZI NO ASSOCIATED BUILDING PERMIT#(if applicable): N/A DESCRIPTION OF WORK: 65 KW generator for acrobatic show at Everett Mall 1402 SE Everett Way, Everett, WA CONTACT INFORMATION OWNER NAME: Leo OSorlo TENANT NAME(If Commercial): OWNER MAILING ADDRESS: STREET 4088 Pleasant Road ,,, Las Vegas sTATF NV zIP 89108 OWNER PHONE: (702) 493-2894OWNER EMAIL: Amerlcancrownclrcus@yahoo.com CONTRACTOR NAME: Owner CONTRACTOR ADDRESS: STREET CITY STATE ZIP CONTRACTOR PHONE: CONTRACTOR EMAIL: CONTRACTOR LIC.#(REQUIRED): CITY OF EVERETT BUSINESS LIC.#(REQUIRED): PRIMARY CONTACT: Z OWNER ❑CONTRACTOR ❑ OTHER(Please Specify) CONTACT NAME: CONTACT PHONE: (702) 493-2894 Leo Osorio CONTACT EMAIL:AmeriCancrowncircus@yahoo.com AGREEMENT:I hereby certify that/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 1 comply with the State Contractors Law 18.27 RCW and 296.200 WAC. City of Everett Official Use Only PER� % ( r?) � Digitally signed by Leoncio Osorio �/-�+ ^1 C DN:cn=Leoncio Osorio,o=American Crown Circus,Inc.,ou=V I V O I 1 c I® V O r I O President,email=Americancrowncircus@yahoo.com,c=US E Date:2017.08.17 09'.44'.05-07'00' Owner/Authorized Agent Signature Date (Revised 9/23/2016)