Laserfiche WebLink
Orerr MCTRICAL PERMIT APICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT,WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 I (E)everetteps@everettwa.gov I www.everettwagovipermits <br /> PROJECT SITE INFORMATION <br /> PROJECT ADDRESS:a9C)q }-iojt Ave e ,�, kk)A R01 <br /> BUILDING AREA(if residential,new construction, remodel,or addition) SF <br /> BUILDING TYPE: o SFR-DETACHED o SFR-ATTACHED o DUPLEX o MULTI-FAMILY-#OF UNITS: COMMERCIAL <br /> USE OF BUILDING: Cx\V1\e <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK:$ �= <br /> NUMBER OF DEVICESlif low voltage): I <br /> FIRE ALARM? ;1¢YES o NO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): � <br /> DESCRIPTION OF WORK: \Y1S ,�,,` <br /> k\akkOn oc- (I ) AGS \' tO r-tosr w'\ A-Ae e_ <br /> cs-ACP <br /> CONTACT INFORMATION <br /> OWNER NAME:EN.le GN\6\�, ^^ TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET ' p(, <br /> CITY ej� C STATE ZIP <br /> OWNER PHONE:I-E �fl�cO 'OWNER EMAIL: <br /> CONTRACTOR NAME:Clocks-6\0,n Sec.(., r�\" c <br /> CONTRACTOR ADDRESS: STREET \ \ l kM, S <br /> CrTY a 1 STATE A ZIP Q,J\- <br /> CONTRACTOR PHONE: ( A CONTRACTOR EMAIL: <br /> CONTRACTOR LIC.#(REQUIRED):[4UAZ. 52WS ICITY OF EVERETT BUSINESS LIC.#(REQUIRED):03331-1143 <br /> PRIMARY CONTACT: o OWNER o CONTRACTOR sr.OTHER(Please Specify) \`C,CkY* <br /> CONTACT NAME:, ,, . S CONTACT PHONE <br /> cJC c Pc �J + CONTACT EMAIL:Fl` , e 9 yel�-�,G\ or1�`� • Cowl <br /> AGREEMENT'I hereby certify that t have read and examined this application and know the same to be true and correct., All provisions of laws and ordinances governing this type <br /> 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 /> PERMIT# <br /> aq \-1 Eft \ -- 2IC <br /> Owner/Authorized Agent Signature Date (Revised 9!23/2016) <br /> 1 7i <br />