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

ELECTRICAL PERMIT APPLICATION 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) 7--5: SF BUILDING TYPE: ❑ SFR-DETACHED ❑ SFR-ATTACHED ❑ DUPLEX ❑ MULTI-FAMILY-#OF UNITS: O-COMMERCIAL USE OF BUILDING: ELECTRICAL APPLICATION INFORMATION CONTRACT PRICE OF WORK: $ NUMBER OF DEVICES(if low voltage): FIRE ALARM? ❑YES )ANO ASSOCIATED BUILDING PERMIT#(if applicable): DESCRIPTION OF WORK: k"t. �i ,;._ VU,c� � U C0'�'�.. CONTACT INFORMATION OWNER NAME: �-a TENANT NAME(If Commercial): OWNER MAILING ADDRESS: STREET Nt; 74 �S S CITY STATE - ZIP OWNER PHONE: OWNER EMAIL: o L.t r . .. . . CONTRACTOR NAME: Z—i /1 L_ CONTRACTOR ADDRESS: STREET �j 2—� d A�')0 ` li f I�/� J // CITY �aferc)4 STATE /ti ZIP CONTRACTOR PHONE: W �I� J"SbS1E' CONTRACTOR EMAIL: P-,24Zrcolw CONTRACTOR LIC.#(REQUIRED): /� 12-<L-L3 S SO A, CITY OF EVERETT BUSINESS LIC.#(REQUIRED) PRIMARY CONTACT: ❑OWNER ®--CONTRACTOR ❑OTHER(Please Specify) CONTACT NAME: _ f J CONTACT PHONE: CONTACT EMAIL: AGREEMENT.'Thereby certify that/have read and examined this application and know the same to be true and correct. All provisions o 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/am authorized by the owner of this property to perform the work for which application is made and/ comply with the State Contractors Law 98.27 RCW and 296.200 WAC. City of Everett Official Use Only FEE �' 00 PERMIT# O rized Agent Signature Date (Revised 10/9212015)