4201 RUCKER AVE COMMUNITY HEALTH CENTER 2019-04-10

4rerr !LECTRICAL PERMIT AILICATION CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET, EVERETT,WA 98201 (P)425-257-8810 I FAX 425-257-8857 1 (E)everetteps@everettwa.gov I www.everettwa.gov/permits c� 5 PROJECT/ SITE INFORMATION �^-� PROJECT ADDRESS: 1430 l R �G�(1 Ave,P\ E\Y e,�Gef W A ‘ RB _C) BUILDING AREA(if residential,new construction,remodel,or addition) SF BUILDING TYPE: 0 SFR-DETACHED 0 SFR ATTACHED 0 DUPLEX 0 MULTI-FAMILY-#OF UNITS: lit,p0MMERCIAL USE OF BUILDING: l�.,e,6 \c ` c, ► Abc\1 n 1 LECTRI•AL APPLICATION INFORMATION CONTRACT PRICE OF WORK:$Is 2 40\a NUMBER OF DEVICES(if low volt-.e): ‘5 k"\ FIRE ALARM? $,YES 0 NO ASSOCIATED BUILDING PERMIT#(if applicable): DESCRIPTION OF WORK: 0f`-e, , e,\C Vn \Y\S A,Ck \I \fl Na Cjt--4 K.Z)) \ CSS CONTACT INFORMATION OWNER NAME:Q M\ N\ \l`c„a\-lv\Cf eir- r AMIE of rcial):C AC \Y * ` nmeM col' av OWNER MAILING ADDRESS: STREET '%(0 Ck eMeklif(C)() U i U p jA V(l w i CIN ��Jµ € c') p1\V STATE WA ZIP Q p„.g��.:J OWNER PHONE: OWNER EMAIL: CONTRACTOR NAME: CC Ockf _Ack'(1 �i�� CONTRACTOR ADDRESS: STREET n k 3 vCANY2 s CITY\e, STATE$)A- ZIPg \ CONTRACTOR PHONE:41D- w -� S CONTRACTOR EMAIL: CONTRACTOR LIC.#(REQUIRED) 1A R � CITY OF EVERETT BUSINESS LIC.#(REi MED):033114 i PRIMARY CONTACT: 0 OWNER 4aONTRACTOR 0 OTHER(Please Specify _ CNTAGT NAME: CONTACT PHONE: Z ( , 2z_ Cr -t `ex-lc_ ?.,z."5. �V U , 0 Se_VL �q } CONTACT EMAIL e ,,,,,,,a .C0h, AGREEMENT:I hereby ,.rt"f, that!have read examined this application and know the same to be trukaub correct. All prow's' of laws and ordinances governing this of work will be complete• ether 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 lam 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 ' PERMIT# Y-1—.A1---- .1' 0(3t--kkit ( ‘OC-1 E k (.)s- \20 Owner/Authorized Agent Signature Date (Revised 9/23/2016)