6301 36TH AVE W BYRAM HEALTHCARE 2017-10-26

foL.ECTRICAL PERMIT AP*ICATION 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 PROJECTADDRESS: &,:e .� L7 % U^ W 1J� V', �.�`, c BUILDING AREA(if residential, new construction, remodel,or addition) SF BUILDING TYPE: ❑ SFR-DETACHED ❑ SFR-ATTACHED ❑ DUPLEX ❑ MULTI-FAMILY-#OF UNITS: 'C;OMMERCIAL USE OF BUILDING: ELECTRICAL APPLICATION INFORMATION CONTRACT PRICE OF WORK: $ S NUMBER OF DEVICES if low voltage): FIRE ALARM? "r ES ❑ NO ASSOCIATED BUILDING PERMIT# if applicable): DESCRIPTION OF WORK: c1 c:"\-C� C CONTACT INFORMATION OWNER NAME: TENANT NAME(If Commercial): OWNER MAILING ADDRESS: STREET CITY STATE ZIP OWNER PHONE: OWNER EMAIL: CONTRACTOR NAME: 0l5 CONTRACTOR ADDRESS: STREET l G CITY /� STATE ZIP C�Gf��j•� CONTRACTOR PHONE: CONTRACTOR EMAIL: CONTRACTOR LIC.#(REQUIRED):��j ,��=' G� , �{'i� - CITY OF EVERETT BUSINESS LIC.#(REQUIRED): lJ ' /(i 2— PRIMARY CONTACT: ❑OWNER CONTRACTOR ❑OTHER(Please Specify) CONTACT NAME: CONTACT PHON E: _3 �} f I7Z2 CONTACT EMAIL- AGREEMENT/ MAIL:AGREEMENT:I hereby certify that/have rad and examined this application and know the san4elto be true a 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# wner/Authorized Agent Signature bate (Revised 9/23/2016)