1124 LOMBARD AVE 2016-05-24 - Laserfiche WebLink

4rETT •ECTRICAL PERMIT A•LICATION CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET, EVERETT, WA 98201 (P) 425-257-8810 I FAX 425-257-8857 I (E) everetteps@everettwa.gov www.everettwa.gov/permits PROJECT SITE INFORMATION PROJECT ADDRESS: 1121-1- LGm b�rt�t,l AveG ver +V iUi BUILDING AREA(if residential, new construction, remodel, or addition) SIder ti -i SF BUILDING TYPE: ❑ SFR-DETACHED ® SFR-ATTACHED ❑ DUPLEX 0 MULTI-FAMILY-It OF UNITS El COMMERCIAL USE OF BUILDING: ELECTRICAL APPLICATION INFORMATION CONTRACT PRICE OF WORK: $ NUMBER OF DEVICES (if low voltage): N/A FIRE ALARM? ❑ YES 0 NO ASSOCIATED BUILDING PERMIT# (if applicable): 14 I A DESCRIPTION OF WORK: rJ(A)ire �j /) CONTACT INFORMATION OWNER NAME: f&n CCn 5 I•I i;1 TENANT NAME (If Commercial): N I P" OWNER MAILING ADDRESS: STREET t24 Loran bard Ave CITY tVe/1'G# STATE v r ' ZIP QV 2.0 OWNER PHONE: r f, G`) `OWNER EMAIL: Nr/P CONTRACTOR NAME: II) �'iOuS� EleeCtt tCQ+,, Jo il }\ �Q t nC • CONTRACTOR ADDRESS: STREET 15720 DI 1D� C l/r sr \/�� -11)1.—}r) � j, //�� 2cny L A kC 64-e VL ^STATE ► `� 1 zip 1 v�� CONTRACTOR PHONE:(#25)23 1—O�/✓q /� CONTRACTOR EMAIL: (UraSC(IrIhoucee/ettric.eon CONTRACTOR LIC.#(REQUIRED): InhOUPS /52ci)( CITY OF EVERETT BUSINESS LIC.#(REQUIRED): D4L 1a PRIMARY CONTACT: - eW,1 -.CSI CONTRACTO , -TZ OTHER Please S - ek I 11 (G1(1(C acifiiiii) CONTACT NAME: CONTACT PHONE:(L)2 )7(p0 -32o3 CONTACT EMAIL: AGREEMENT.T hereby certify that 1 have read and examined this application and know the same to be true and correct. All provisions of laws and ordinances governing this 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 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 comply with the State Contractors Law 18.27 RCW and 296.200 WAC. City of Everett Official Use Only FEE 44) I .. PERMIT# 4/, FL9b. - E OL6 Owner/Arrthorize�i e t Signature Date (Revised 10/1212015)