Laserfiche WebLink
4rETT ELECTRICAL PERMIT APPLICATION <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.everettwa.gov/permits <br /> �l 1` PROJECTSITE INFORMATION <br /> PROJECT ADDRESS: (43(.1i b4 tAP;(,C-, <br /> BUILDING AREA(if residential, new construction, remodel,or addition) SF <br /> BUILDING TYPE: itSFR-DETACHED 0 SFR-ATTACHED 0 DUPLEX 0 MULTI-FAMILY-#OF UNITS: 0 COMMERCIAL <br /> USE OF BUILDING: <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK: $ II.JO <br /> NUMBER OF DEVICES (if low voltage): <br /> FIRE ALARM? 0 YES 0 NO <br /> ASSOCIATED BUILDING PERMIT{I"D#(if applicable): , r <br /> DESCRIPTION OF WORK: (,k. i +S ',,,,y poAl Q v '� 'NN ke., <br /> J I( CONTACT INFORMATION <br /> OWNER NAME: �j�- -`\(/A 1,�;A\:,t TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET �y ' <br /> (J ,(y tr,s Y� <br /> CITY t�'v.{,. '` STATE A, ZIP e -2.40,-, <br /> -- <br /> OWNER PHONE: Q !- , . 1 41� OWNER EMAIL: <br /> CONTRACTOR NAME: 1 Gl. sen i 1{� 'h V Y�Q �Tl(YY� �o 1 G( tion' <br /> CONTRACTOR ADDRESS: STREET f o (moo e ICI 9 111 (A ��/� <br /> CITY �/��(.��, STATE VV G' ZiP 1�� L 0 <br /> CONTRACTOR PHONE: 0 ' c- ) ' q("Jco CONTRACTOR EMAIL: 1 Irit, C1)) G{. 6C.- k-ati '��-C } <br /> CONTRACTOR LIC.#(REQUIRED): 1)44\c t\1,.kIr'� 3R-44 CITY OF EVERETT BUSINESS LIC.#(REQUIRED): C''�7' t6.:)� <br /> PRIMARY CONTACT: 0 OWNER $CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: ;3 D , tpcL) . c-S <br /> k3tivikA, 6Q,birlir\i/Lo CONTACT EMAIL: '1 v (ft) >. -\ Ji6 f <br /> AGREEMENT:I hereby certify that I have read and examined this application and know the same to be true and corrdct. All provis7dns of laws and ordinangoverning 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 l 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 /> IPERMIT# <br /> 10 1 11 1 i & E RI0- (2� <br /> Owner/A tho '--d Age t Signature Date (Revised 9/23/2016) <br /> 1 <br />