11632 EVERGREEN WAY DOMINOS PIZZA 2019-02-06

E ECTRICAL PERMIT APP (CATION I�►' , CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET, EVERETT,WA 98201 (P)425-257-8810 FAX 425-257-8857 1 (E)everetteps@everettwa.gov 1 www.everettwa.govipermits PROJECT SITE INFORMATION PROJECT ADDRESS: 116?2 L V V`e-eJV\. 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: l OMMERCIAL USE OF BUILDING: ELECTRICAL APPLICATION INFORMATION CONTRACT PRICE OF WORK:$ 5-(-9 p NUMBER OF DEVICES(if low voltage): FIRE ALARM? 0 YES 0 NO ASSOCIATED BUILDING PERMIT#(if applicable): DESCRIPTION OF WORK: CIG II - �� r i ) 1 ei �,,,o 7 CONTACT INFORMATION OWNER NAME: 1)4-6 far - _-- TENANT NAME(If Commercial): {74 € OWNER MAILING ADDRESS: STREET CITY STATE ZIP OWNER PHONE: OWNER EMAIL: CONTRACTOR NAME: STPey CONTRACTOR ADDRESS: STREET / / 6 H-(7 f'q al" A '�/,�/�- /�,� CITY 1 Yr9/�0`, / STATE VSO' ZIP 90'a3/1 CONTRACTOR PHONE: —Z —0 yICONTRACTOREMAIL: ,,,.p V-. -e CONTRACTOR LIC.#(REQUIRED): � � CITY OF EVERETT B�INESS LIC. C�s.� �Y� SyerT,5 9.2 i� //REQUIRED): PRIMARY CONTACT: 0 OWNER CONTRACTOR 0 THER(Please Specify) CONTACT NAME: CONTACT PHONE: 2 00 3-Arr f?aYk— CONTACT EMAIL: pywr ( e„ / , . r AGREEMENT:I hereby certify that I havi read and examined this application and know the san�be true and correct./All proms of fa and=financesgoverning 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 -3 - E Owner/Authorized Agent Signature Date (Revised 9/23/2016)