Laserfiche WebLink
477 ELECTRICAL PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES ORIGINAL <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> (P) 425-257-8810 1 FAX 425-257-8857 1 (E) everetteps@everettwa.gov www.everettwa.gov/permits <br /> I�n PROJECT SITE INFORMATION <br /> PROJECT ADDRESS: 7i. (') <br /> BUILDING AREA(if residential, new construction, remodel,or addition) V1 q,j SF <br /> BUILDING TYPE: SFR-DETACHED ❑ SFR-ATTACHED 0 DUPLEX 0 MULTI-FAMILY-#OF UNITS: ❑ COMMERCIAL <br /> USE OF BUILDING: <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK: $ <br /> NUMBER OF DEVICES (if low voltage): <br /> FIRE ALARM? ❑YES ❑ NO <br /> ASSOCIATED BUILDING PERMIT# (if applicable): <br /> DESCRIPTION OF WORK: Add C.i -eojH P(1 w p (63 i <br /> CONTACT INFORMATION <br /> OWNER NAME:$ QeL.e (Joe, 'V TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET 2.1)001 <br /> ')001 31- S <br /> CITY �/1/.it/f STATE )J1- ZIP z0,5 <br /> OWNER PHONE: 11./b " ' c3 5 31 OWNER EMAIL:3b(VE- \;ooay,(cm <br /> CONTRACTOR NAME:,15, ).Q F!C1 <br /> CONTRACTOR ADDRESS: STREET 7t\ iO ,+ I �,,(221.1- S� at <br /> CITY F I( 1 ly n � An (f 1 V( C� t STATE / ZIP q�4 . <br /> CONTRACTOR PHONE:1.1 1D— ( — ! CONTRACTOR EMAIL: iv lt" f(/Y I a <br /> � _ � G1 1}ill � � tie �� (J�'rl �C I� <br /> CONTRACTOR LIC.#(REQUIRED): LO R-j T JX V.1� CITY OF EVERETT BUSINESS LIC.#(REQUIRED):6.7,-r <br /> PRIMARY CONTACT: 0 OWNER CONTRACTOR 0 OTHER(Please Specify) <br /> CON .T NAME: CONTACT PHONE: 117J ---71 _7 136 <br /> itrY V i, CONTACT EMAIL: •1n -311 gi <br /> oilf }rn <br /> AGREEMENT:T hereby certify that I have ead and amined this application and know the same to be true and correct. All provisions of laws and ordinances governing this <br /> 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 <br /> 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 <br /> comply with the State Contractors Law 18.27 RCW and 296.200 WAC. <br /> City of Everett Official Use Only <br /> FEE <br /> r PERMIT# <br /> vole E 'GO I (-}t1 <br /> Owner/A• ori�-. gen ,.nature Date (Revised 10/12/2015) <br />