3726 BROADWAY CONCENTRA URGENT CARE 2019-06-19

416-77. ECTRICAL PERMIT APSICATION CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET, EVERETT, WA 98201 (P)425-257-8810 I FAX 425-257-8857 1 (E)everetteps@everettwa.gov 1 www.everettwa.gov/permits PROJECT SITE INFORMATION PROJECT ADDRESS: 37. 4 4C.4.161/ CI-21''''t--- i t)) BUILDING AREA(if residential,new construction,remodel,ofaddition) SF BUILDING TYPE: 0 SFR-DETACHED 0 SFR-ATTACHED 0 DUPLEX 0 MULTI-FAMILY-#OF UNITS: 0 COMMERCIAL USE OF BUILDING: ELEOTRICAL A PLICAT�O1±1 orwsortawrown 110N CONTRACT PRICE OF WORK: $ I PO15 .OV NUMBER OF DEVICES(if low voltage): FIRE ALARM? 0 YES 0 NO ASSOCIATED BUILDING PERMIT#(if applicable): DESCRIPTION OF WORK: -r-y�s c-,lt, te:,^j,N 0 e L...4446,5 (,,, i L. 1-1.51,-1-11 CONTACT INFORMATIIQN .. %.!� .. .. /., OWNER NAME: TENANT NAME{If Commercial): ch - Lij Ftve OWNER MAILING ADDRESS: vataer CITY STATE ZIP OWNER PHONE: OWNER EMAIL: { CONTRACTOR NAME: J �~' S CONTRACTOR ADDRESS: C STREE .- j- • L,, l/ A CITY Yh VOL, ) STATE t w /L\ ZIP 7,9036 CONTRACTOR PHONE: 47.9r---->2�? ._--02CONTRACTOR EMAIL: e �lll `5: c.- P�., CONTRACTOR LIC.#(REQUIRD): CITY OF EVERETT ESS LIC.#(REQUIRED): 5792-0 PRIMARY CONTACT: 0 OWNER TRACTOR 0 OTHER(Please Specify) CONTACT NAME: CONTACT PHONE: e29Z n—a!'W G✓' CONTACT EMAIL: `N � e% _ f.Cite,.. AGREEMENT:1 herebycertifyth t 1 C have read and examined this application and know the sa be true and correct. All rovisi 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 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 18.2?RCW and 296.200 WAC. City of Everett Official Use Only PERMIT# ,"0=—/e.—/3 E t2101 — 0 VO Owner/Authorized Agent Signature Date (Revised 9/23/2016)