4128 RUCKER AVE SAFEWAY FUEL STATION 2018-06-27

"I1Pb ,LECTRICAL PERMIT liPPLICATION • CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET, EVERETT, WA 98201 (P)425-257-8810 I FAX 425-257-8857 I (E)everetteps@everettwa.gov www.everettwa.gov/permits PROJECT SITE INFORMATION PROJECT ADDRESS: 1-(1. QC" 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: c-kirCI:-.7-NVIMERC1AL USE OF BUILDING: ELECTRICAL APPLICATION INFORMATION CONTRACT PRICE OF WORK:$ C-) NUMBER OF DEVICES(if low voltage): FIRE ALARM? 0 YES 40.10 ASSOCIATED BUILDING PERMIT#(if applicable): DESCRIPTION OF WORK: • peere-) 06\9 S — ° - - CONTACT INFORMATION OWNER NAME: Sere(2c• -1\''‘ TENANT NAME(If Commercial): StrrE--4-"--4--kl) OWNER MAILING ADDRESS: STREET CITY STATE ZIP OWNER PHONE: OWNER EMAIL: CONTRACTOR NAME: `;S- Pee–A-;?—H CONTRACTOR ADDRESS: STREET r Cake- C11 Y STATE et.4- ZIP 4283 7 CONTRACTOR PHONE: ‘••••?-2,,:-.)(- t.7— CONTRACTOR EMAIL: 1,,,R1-\.o g_r-l-e 64 c 0117_Ez) - - CONTRACTOR LIC.#(REQUIRED): Oce-N,C.:f:-'1.-E-::_r--*R2/LgE. CITY OF EVERETT BUSINESS LIC.#(REQUIR:9): 5 () PRIMARY CONTACT: DOWNER /ErCONTRACTOR 0 OTHER(Please Specify) CONTACT NAME: CONTACT PHONE: 3 ) Ths ( 2- /44 CONTACT EMAIL: (' ,f‘.4.\_.D 045/ (''tpcw,••-‘1‘Orl AGREEMENT:Thereby 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 lam 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 FEE t ( e' PERMIT# E \cn _035 Owner/A rized Agent Signature Date (Revised 10/12/2015)