2930 MAPLE ST GROUP HEALTH 2018-11-13

47"7" ELECTRICAL PERMIT AOLICATION 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 I www.everettwa.gov/permits ' PROJECT'SITE INFORMATION PROJECT ADDRESS: Q(1 / r \ Pk PL ST )�.e- [„-=-7-'j— 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: <COMMERCIAL USE OF BUILDING: ELECTRICAL APPLICATION INFORMATION CONTRACT PRICE OF WORK: $ 3 0p_oo NUMBER OF DEVICES (if low voltage): FIRE ALARM? 0 YES IANO ASSOCIATED BUILDING PERMIT#(if applicable): DESCRIPTION OF WORK: 'R (;k,<.0 �' �C.-1. Ct®' CONTACT INFORMATION OWNER NAME: i?..-C)V f) a L"( F-1 TENANT NAME(If Commercial): GaaR �p_a,\ OWNER MAILING ADDRESS: STREET a‘ w il,• _L ..s-1- CITY c E .r I LE STATE A / _ zip('N> 1 a{ OWNER PHONE: OWNER EMAIL: CONTRACTOR NAME: qz, E CONTRACTOR ADDRESS: STREET t ARD 5 NV grt t_ 17 O 0 /'1 CITY 3 LE STATE W P /ZIP 9g./0 O 1 CONTRACTOR PHONE: e2)6- r7,4 7, 1 l Qj CONTRACTOR EMAIL: mon G,nu c L vQ k(._r 0V9 CONTRACTOR LIC #(REQUIRED) C3 CSE., 4 C.? CITY OF EVERETT BUSINESS LIC #( QUIRED) CY4Vp.3/j PRIMARY CONTACT: 0 OWNER ( CONTRACTOR 0 OTHER(Please Specify) CR—ACT NAME: CONTACT PHONE: acy.o - 1-7i7 (,,,\.. I . (:)\-\--(-•\L\L ► V c.,k\N OUnk/C) CONTACT EMAIL: FYI CYYI GL n V a .q/NC_ r C'S� AGREEMENT::T hereby certify that I have read and examined this application and know the same to and correct. All provisions of laws and ordinadces governing�t i 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 std"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 FEE 4, 6,\,,50 0 , . PERMIT# 1t ! E J Roy of 4. !'� lo� El (Dip Owner/Authorized Agent Signature Date (Revised 10/12/2015)