4310 COLBY AVE WESTERN WASHINGTON MEDICAL GROUP 2019-03-13

i ELECTRICAL PERMIT APPLICATION .... CITY OF EVERETT-PERMIT SERVICES 3200 CEDAR STREET, EVERETT, WA 98201 (P)425-257-8810 1 FAX 425-257-8857 1 (E)everetteps@everettvva.govi Amweverettwa.govipermits PROJECT SITE INFORMATION PROJECT ADDRESS: q.30 .C.u i6i Av a zt.2L)s vcre+4- ti)it le 2.6 1 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: 0 r p Its y Aitetht...ck ELECTRICAL APPLICATION INFORMATION CONTRACT PRICE OF WORK:$ 3 000.'' -.-- NUMBER OF DEVICES(if low voltage): FIRE ALARM? 0 YES NO ASSOCIATED BUILDING PERMIT#(if applicable): DESCRIPTION OF WORK: I it,‘e i i.1 rce_cfh...c.14- 1 i A 4 -cam Rim tp f,215' 4 Old t etztli-excieck CILIO/Or r tetc-eca _ Dic CONTACT INFORMATION OWNER NAME: i Gde. -le_rvt I.J.A.:tv,% t 1_• a9 41 Att._et l'er..e,_ 6 rirn r`toerciat : OWNER MAILING ADDRESS: smerr 431* 4 lb_ 4ii Ae- ary ,I.Z.Pe.:1-f-. STATE 14) ye `,8zo$ OWNER PHONE: -------10WNER EMAIL: CONTRACTOR NAME: VE.C..4 E te...c.41--;sc.- CONTRACTOR ADDRESS: sma-r 5-‘1L1 -3T" iek:E. 3 ary Sea444.e._ s-rATE 4)4 zip .eigi)10 CONTRACTOR PHONE: 2C4- 436,-52.0 0 [CONTRACTOR EMAIL: CONTRACTOR LIC.#(REQUiRED): Ire-44 EC-At SI/2-AL) ICITY OF EVERETT BUSINESS LIC.tRREOUIRED):613q "/S- .. PRIMARY CONTACT: DOWNER 0 CONTRACTOR pEOTHER(Please Specify) rl,tC 6,-Ftervz f fl-c.,...t.g..1 CONTACT NAME: CONTACT PHONE: 24, - s-o SC GEA;G04-4-1) CONTACT EMAIL: .3asoyl.. Sc 40E4 .4.,..., „ilEcA,copt.i. AGREEMENT:I hereby Certify that I have reed and examined this application and know the same to be true and coma 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 cerncel the provisions of any other state or local law regulating constaxtion 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? comply with the State Contractors Law 18.27 RCM/and 296.200 WAG. City of Everett Official Use Only PERMIT# • `*4-"*..,---/"Z sY3//s O rlAuthorized A nt Signature 0 e ' (Revised 9/23/2016)