Laserfiche WebLink
LCTRICAL PERMIT APIkthATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> (P)425-257-8810 } FAX 425-257-8857 (E) everetteps@everettwa.gov J www.everettwa.gov/permits <br /> PROJECT SITE INFORMATION <br /> PROJECT ADDRESS: 1./ <br /> BUILDING AREA(if residential,new construction, remodel,or addition) SF • <br /> BUILDING TYPE: 0 SFR-DETACHED/� _ 0 SFR-ATTACHED 0 DUPLEX 0 MULTI-FAMILY-#OF UNITS: M COMMERCIAL <br /> USE OF BUILDING: l�'n-GU4 0' e-14-1 <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK:$ /000 <br /> NUMBER OF DEVICES(if low voltage): <br /> FIRE ALARM? 0 YES *10 <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIPTION OF WORK: p/ - 7/14- L ji/Lf •j4- LOA-y X61✓ Ij -/ <br /> CONTACT INFORMATION. <br /> OWNER NAME: CA.( 17.�9"l�- � TENANT NAME(If Commercial): /11�I 5" 1/4 <br /> OWNER MAILING ADD13,ESS: STREET, ��1 7 17-4,e/26-z_- <br /> e -fi' on), !N/ STATE 72-2.e, ZIP <br /> OWNER PHONE: 11-9-5— - 3l / OWNER EMAIL: <br /> CONTRACTOR NAME: /4X.1 7� 2.1#C( <br /> � .,..N.. <br /> CONTRACTOR <br /> ADDRESS: STREET 12-4' om/�`� <br /> CITY w,// F O 2 2 #04- <br /> CONTRACTOR <br /> STATE ZIP <br /> CONTRACTOR PHONE: 3'�v 9�P ICP J'-D`�"4 . ,,!! _ /CONTRACTOR EMAIL: �l"'0 <br /> CONTRACTOR LIC.#(REQUIRED)1 �" th*-46E-�3D SL CITY OF EVERETT BUSINESS LIC.#(REQUIRED)' <br /> PRIMARY CONTACT: )6OWNER 0 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: rf CONTACT PHONE: Z- 2 5-2 31 le5L <br /> i t T fr(- CONTACT EMAIL: -e..-6Y <br /> AGREEMENT:T hereby certify that I have read and examined 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 properly 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 /> ..tge OPP zyi PERMIT# <br /> 41? E - <br /> Owner/Authorized Agent Signature I ate (Revised 10/12/2015) <br /> cgt,,,,,j, <br />