6003 23RD DR W SUPPORT MED 2019-06-12

41ffir LECTRICAL 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@everettwa.gov I www.everettwa.gov/permits PROJECT SITE INFORMATION , :- PROJECT PROJECT ADDRESS: 60O3 Z3rd Dr W CE 1 'O3` I ' LI) 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: ELECTRIC L APPLICATION INFORMATION CONTRACT PRICE OF WORK: $ Lei 00 NUMBER OF DEVICES(if low voltage): FIRE ALARM? 0 YES 0 NO ASSOCIATED BUILDING PERMIT#(if applicable): +- DESCRIPTION OF WORK: Ins- .t 1 c- rece.P'�'ac,1 e s 1 3 s - ;+r—l'?e-5 -' Rel ocu.to I-r er" ct.itJ ctd) 3 drb(pers, rn eJ svppc'f CONTACT INFORMATION OWNER NAME: I O C. 1'I I ck nGIQ�,,encie t- TENANT NAME(If Commercial): OWNER MAILING ADDRESS: STREET •! 5e(Vt CCS CITY STATE ZIP OWNER PHONE: OWNER EMAIL:- CONTRACTOR NAME: 0 1 St n E leer t c _1.../- CONTRACTOR ADDRESS: STREET 3Z S Wash i n9 min ior'K. S .44. G1 I CITY yi e i ( STATE (AJA- A 1 ZIP q SZO3 t. CONTRACTOR PHONE: Z5 3 '72l qV s— CONTRACTOR EMAIL: C�USICAY\ K. CAS-C✓.e te-cky 1 c.•vtek CONTRACTOR LIC.#(REQUIRED): Q(_.5ENErg3( PE CITY OF EVERETT BUSINESS LIC.#(REQUIRED):O /6/OZ PRIMARY CONTACT: 0 OWNER .ONTRACTOR 0 OTHER(Please Specify) CONTACT NAME: CONTACT PHONE: -LS-3 £72... Lo S- Rvs\otn ttlo--crn C% \.. CONTACT EMAIL: rUS lay\ J( C&OLS.C.41C-k r'1L.1 " 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# ,i_,.1111i0011. !7 i E s'i,b1-k --dam Owner/Authori`i• Signatur Date (Revised 9/23/2016)