4919 EVERGREEN WAY QFC 2018-01-03

� �ECTRICAL PERMIT APF'LICATION CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET, EVERETT, WA 98201 (P) 425-257-8810 � FAX 425-257-8857 � (E) everetteps@everettwa.gov � www.everettwa.gov/permits �� '�PROJEGT�StTE I��+IFORMATION PROJECT ADDRESS: 4919 EVERGREEN�'VAY, EVERETT WA 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: RETAIL ELECTRICAL APPLi'GATION INFORMATION CONTRACT PRICE OF WORK: $ 1200 NUMBER OF DEVICES (if low volta e): FIRE ALARM? ❑YES I$�NO ASSOCIATED BUILDING PERMIT#(if a licable : DESCRIPTION OF WORK: WIRF,FOR MF..AT MONITOR ' CCINTAGT 1NFG►RMATION '` OWNER NAME: QFC TENANT NAME(If Commercial): FC OWNER MAILING ADDRESS: srReer CITY STATE ZIP OWNER PHONE: OWNER EMAIL: CONTRACTOR NAME: STONER ELECTRIC CONTRACTOR ADDRESS: sTREer 1904 OCHOCO cirY MILWAUKIE srnrE OR ziP 97222 CONTRACTOR PHONE: 503-462-E�$00 CONTRACTOR EMAIL: PEI2MI�TS@STONLRGROUP.COM CONTRACTOR LIC.#(REQUIRED): STONEEC322PG CITY OF EVERETT BUSINESS LIC.#(REC2U1 D): PRIMARY CONTACT: ❑OWNER �CONTRACTOR ❑OTHER(Please Specify) CONTACT NAME:JONATHAN FRANCIS CONTACT PHONE: 503-462-6500 coNTACT ennai�: PERMITS@STONERGROUP.COM AGREEMENT:T hereby certify that 1 have read and examined this application and know the same to be true and correct. All provisions of/aws and ordinances governing fhis 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 cance/the provisions of any other state or local law regu/ating 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 l comply with the State Contractors Law 18.27 RCW and 296.200 WAC. City of Everett Officia/Use Only FEE �� ,./ PERMIT# .-;� � �,� E �C�o� - �� , � 7-29-16 Owner/Authorized Agent Signature Date (Revised 10/12/2015)