10200 25TH AVE SE 2019-11-15 - Laserfiche WebLink

#1111j7a ELECTRICAL PERMIT APPLICATION Niirgi- CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET, EVERETT, WA 98201 (P)425-257-8810 ( FAX 425-257-8857 1 (E)everetteps@everettwa.gov 1 www.everettwa.gov/permits ++�� 1," PROJECT SITE INFORMATION� PROJECT ADDRESS: ) V2 0 D 2 5+11 i C E� ��s'Y't _ .. j l) 0 c y� }oE BUILDING AREA(if residential, new construction, remodel;or addition) r Bi l }U 2 I VSF U l BUILDING TYPE: 0 SFR-DETACHED 0 SFR-ATTACHED 0 DUPLEX 0 MULTI-FAMILY-#OF UNITS: L211COMMERCIAL USE OF BUILDING: S di - ill h I ELECTRICAL APPLICATION INFORMATION CONTRACT PRICE OF WORK: $ 7-2_LVD NUMBER OF DEVICES (if low voltage): FIRE ALARM? ❑YES ILTIO ASSOCIATED BUILDING PERMIT#(if applicable): }} DESCRIPTION OF WORK: C1r 1 V)DI 0l LIs !JY F/StiVtt '"`A c' 1/1(9- 1'��t/j1� in sib ( )61 t,''ir Ap 7i 9-h if_µ) Ica t9 )C'i CONTACT INFORMATION r �.v� OWNER NAME: 'Y t n Sc� t ) GI (S � TENANT NAME(If Commercial): :V c' r+t--€ OWNER MAILING ADDRESS: STREET 30)in 3 rTa '� (' (,� C11Y 7..; STATE L j t>P/�✓J "' OWNER PHONE: ®2 C"-... p , j`°° �y` OWNER EMAIL: -l CONTRACTOR NAME: j 1 Itryc, a L 1 l t. CONTRACTOR ADDRESS: STREET )C) (?1) eAferly 17cl KY Cif CITY' C.u e rt l-/ STATE 1, L"` z R qV '7 CONTRACTOR PHONE:LP-5--5- 3' S- ) ci CONTRACTOR EMAIL: CONTRACTOR LIC.#(REQUIRED):.'SI 1,_.T C.5- c 7j3 Lm) CITY OF EVERETT BUSINESS LIC.#(REQUIRED): Q.9) 097 PRIMARY CONTACT: 0 OWNER CONTRACTOR 0 OTHER(Please Specify) — __---- CONTACT NAME:- CONTACT PHONE: t.2,. S )S cli } r I� trot C CONTACT EMAIL: ch r) C: G/04 �� 1 IJr v c `T�y-m,in�� trtikl ' AGREEMENT:I hereby certifythat I have read and examined this application and know the same to be true and correct. Al/provisions a ws and ordinances governing this typet,il6 t 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!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# (3, - - �` E k9)0(e - 0622 Owner/Authorized Agen(631gnature Date (Revised 9/23/2016)