Laserfiche WebLink
ELECTRICAL PERMIT APPLICATION <br /> 411g1 CITY OF EVERETT PERMIT SERVICES <br /> 1I�� 3200 CEDAR STREET, EVERETT, WA 98201 <br /> (P)425-257-8810 } FAX 425-257-8857 I (E)everetteps@everettwa.gov J www.everettwa.gov/permits <br /> f PROJECT SITE INFORMATION <br /> PROJECT ADDRESS: X52 S dd. <br /> BUILDING AREA(if residential,new construction,re odel,or addition) SF <br /> BUILDING TYPE: 0 SFR-DETACHED 0 SFR-ATTACHED 0 DUPLEX 0 MULTI-FAMILY-#OF UNITS: 0 COMMERCIAL <br /> USE OF BUILDING: et.cct <br /> • <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: cc d 04,,.1I<- C l G y�+a,�,.�°�- (314.6(042, (.:T)I4.—. A.,614./ <br /> Ldp <br /> (.4-(/)v"+-e Zr <br /> • <br /> CONTACT INFORMATION • <br /> • <br /> OWNER NAME: &L'L L/4 ,1, .t...) TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET 5 AZA Le) <br /> it <br /> c" tv� STATE t,(.2A-t ZIP <br /> OWNER PHONE:ittA" — /607 OWNER EMAIL: <br /> CONTRACTOR NAME: l..V csp (.44-re l-1)')A c- A i <br /> CONTRACTOR ADDRESS: STREET 'Z.I 20 % t.-47G , <br /> CITY az-ear Z i STATE CI , , ZIP 9-8 <br /> CONTRACTOR PHONE(4/7-61 CONTRACTOR EMAIL: <br /> CONTRACTOR LIC.#(REQUIRED): 'j',5j'1.j ) CITY OF EVERETT BUSINESS LIC.#(REQUIRED),06'7�rjc <br /> PRIMARY CONTACT:- D OWNER SCONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: 1/4.(24-3',- 25'2- / <br /> ''Lt..) CONTACT EMAIL: k- oy cP'5S,v7 iu *CIYJ)nz <br /> AGREEMENT:I hereby certify that I have read and examined this application and know the same to be true and correct. Al!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 lam 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 298.200 WAC. <br /> City of Everett Official Use Only <br /> PERMIT# <br /> 6::;:‘ <br /> Owner/Authorized Agent Signature Date (Revised 9/23/2016) <br />