1815 13TH ST SEATTLE CHILDRENS NORTH CLINIC 2019-06-05

ELECTRICAL PERMIT APPLICATION -- ,- 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: 1.g (Ij ( j�Lr c--I le`44- BUILDING AREA(if residential,new construction,remodel,or addition) SF BUILDING TYPE: 0 SFR-DETACHED ❑'ISFR-ATTACHED 0 DUPLEX 0 MULTI-FAMILY-#OF UNITS: 4j OMMERCIAL USE OF BUILDING: � ( iaa- Lj t,J e;4, 1 1 --- //t.; - ELECTRICAL APPLICATION INFORMATION CONTRACT PRICE OF WORK:$ ti I OU I>®Cb NUMBER OF DEVICES(if low voltage): FIRE ALARM? 0 YES ZIO ASSOCIATED BUILDING PERMIT#(if applicable): DESCRIPTION OF WORK: „Al '.0 t,0%-p-r i P'S CONTACT INFORMATION. . OWNER NAME: 4--(di-, in - 45 TENANT NAME(If Commercial): Ct.i,i..Lr'e- 5/44-.40 OWNER MAILING ADDRESS: STREET r 1b.x' 6.k CrrY & G]6- t/ STATE /f - L' zip l6b.2, OWNER PHONE: " Z'-%— I'I.L- /9.'1 OWNER EMAIL: M.�jcL LS 4'1 c o►U.r;4-11 j1 ,Gss� CONTRACTOR NAME: Jk- wuw�i Qdtsyso r' GC n,vl LoAle-- CONTRACTOR ADDRESS: STREET L��( yy 13 el CITY /14-04.-1/6"L/A.0 STATE L.-/GL. ZIP (9&7•7( CONTRACTOR PHONE: '+Z ' 2 S ((0-51 CONTRACTOR EMAIL: {�,e,erds- C"'� Gt4.,kj,De/' CONTRACTOR LIC.#(REQUIRED): V"ro m p G elq SL k CITY OF EVERETT iBUSINESS LIC.#(REQUIRED): 4/1/(c PRIMARY CONTACT: ❑OWNER CONTRACTOR 0 OTHER(Please Specify) ' - CONTACT NAME: CONTACT PHONE: y/� fj - 2 6 1,g' CONTACT EMAIL: J144--y AGREEMENT:T here y certify that I h read and examined this application and know the same to be true anb 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 PERMIT# E (?),O -042, Owner/Authorized Agent Signaturd- Date (Revised 10/12/2015)