3305 NASSAU ST WA CENTER FOR PAIN MANAGEMENT 2018-12-21

grr ELECTRICAL PERMIT APPLICATION 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 PROJECT SITE INFORMATION PROJECT ADDRESS: 3305 NI $5av 5k BUILDING AREA(if residential,new construction,remodel,or addition) SF BUILDING TYPE: ❑ SFR-DETACHED 0 SFR-ATTACHED 0 DUPLEX 0 MULTI-FAMILY-#OF UNITS: Gr6OMMERCIAL USE OF BUILDING: ELECTRICAL APPLICATION INFORMATION CONTRACT PRICE OF WORK: $ SOO.OZ NUMBER OF DEVICES(if low voltage): I-4 FIRE ALARM? 0 YES 63 NO ASSOCIATED BUILDING PERMIT#(if applicable): D- DESCRIPTION OF WORK: r►5�z 'R� c� `''o C 2' atitte-rt 5-? ww - jo L & 3L IS. CONTACT INFORMATION G OWNER NAME: ,e panJ1✓ E 1 L' z. TENANT NAME(If Commercial):o-Oki awn Cen- -f PAM OWNER MAILING ADDRESS: STREET Vt i q D N6r �� \n/ , 51./a k a-6 l�A einen.'r' CITY �iRY4)"e STATE 144c. ZIP "10a)"7 OWNER PHONE: OWNER EMAIL: CONTRACTOR NAME: 'tV`�VI ��e ra�� f!-. C� CONTRACTOR ADDRESS: STREET 12,-7 ,50 ✓41`Ljt,vt .5 1 j CRY 5 STATE \A/7\-- ZIP 018 10 CONTRACTOR PHONE:2176— 63_V1 LH CONTRACTOR EMAIL: 1,.L 2.v ttih ,room CONTRACTOR LIC.#(REQUIRED): ER6-124-1 SZ3 l3 CITY OF EVERETT BUSINESS LIC.#(REQUIRED): 0/4435 v PRIMARY CONTACT: ❑OWNER Q ONTRACTOR 0 OTHER(Please Specify) CONTACT NAME: CONTACT PHONE: 7 .'761— IZCf gaj -2.`fAkeAL '7 Uv-- CONTACT EMAIL: - ee.vo,�itccbiblvscc,11>P11- AGREEMENT:I hereby certify that I 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 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 PERMIT# /Kin ED 0(04 Owner/Authorized Agent Signature Date (Revised 9/23/2016)