11419 19TH AVE SE SILVER LAKE ACUPUNCTURE 2019-06-11

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 www.everettwa.gov/permits PROJECT SITE INFORMATION PROJECT ADDRESS: //`'y!' t yHt i S em4 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: 0 COMMERCIAL USE OF BUILDING: ELECTRICAL APPLICATION INFORMATION CONTRACT PRICE OF WORK:$ • NUMBER OF DEVICES(if low voltage): FIRE ALARM? 0 YES jgrNO ASSOCIATED BUILDING PERMIT#(if applicable): DESCRIPTION OF WORK: 4,,,, f 9771 G,—(1^C 66"S17 57t Ci v-c_d '1s CONTACT INFORMATION. . OWNER NAME: TENANT NAME(If Commercial): OWNER MAILING ADDRESS: STREET V orrY STATE ZIP OWNER PHONE: OWNER EMAIL: CONTRACTOR NAME: G'V,:k fit,S CONTRACTOR ADDRESS: STREET / "j 77 CIN 4,714L./ �&cl / STATE WTD ZIP ,0,7 CONTRACTOR PHONE: ( jam)— 6 16 9216 CONTRACTOR EMAIL: Pug Ti e?. 7e5 L°"a 1 I I. Co>4/1/4- CONTRACTOR LIC.#(REQUIRED)• W ( CITY OF EVERETT USWESS #(REQUIRED): PRIMARY CONTACT: 0 OWNER h.CONTRACTOR 0 OTHER(Please Specify) CONTACT NAME: CONTACT PHONE: 1/26— �,/ — 26 C (ice Wti CONTACT EMAIL: tatikim, e, C (_ AGREEMENT.:T hereby c ,tify that I have read and examined this application and know the same to be true and cgicect. All provisio/s 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 98.27 RCW and 296.200 WAC. City of Everett Official Use Only FEE a PERMIT# °CIelIid/ E I go'-° 39 Owner/ orized Agent Signature Date (Revised 90/92/2095)