Laserfiche WebLink
4E-rr 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 /> PROJECT SITE INFORMATION <br /> PROJECT ADDRESS: go) vok-k I0A Av. L <br /> BUILDING AREA(if residential, new construction,remodel,or addition) 1/717 SF <br /> BUILDING TYPE: 0 SFR-DETACHEDJSFR-ATTACHED 0 DUPLEX 0 MULTI-FAMILY-#OF UNITS: 0 COMMERCIAL <br /> USE OF BUILDING: $fiL <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK: $ `J SO-o0 <br /> NUMBER OF DEVICES(if low voltage): <br /> FIRE ALARM? 0 YES r�-Y� <br /> NO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): �+ <br /> DESCRIPTION OF WORK: 4a11�f/t!(a j-rAGz-P. t t/— 6A <br /> CONTACT INFORMATION <br /> OWNER NAME: r-k)./11- 517/4-44(5. TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET /2'b( V / -6i,J)A AVG �//� <br /> CITY ev'G/✓&ir STATE 1/1/411 ZIP n <br /> OWNER PHONE: L-1 LJ 3I g'-"'SOLI , �OWNE(R�E/M�AIL: <br /> CONTRACTOR NAME: 504m1'✓G� ✓ 2 "� JL-1 l'C/!✓j <br /> CONTRACTOR ADDRESS: STREET 244 `l Z c- �f <br /> �/ CITY go-'}ti(r�l t-- STATE '�J�V ZIP/'/meg.°/ <br /> CONTRACTOR PHONE: `77.4-tion--.94'(' CONTRACTOR EMAIL: $t/ri/©ANt.E/e 2 @/�'�s 1✓-c< <br /> CONTRACTOR LIC.#(REQUIRED): 5U ODA,ES 041--1V CITY OF EVERETT BUSINESS LIC.#(REQUIRED): <br /> PRIMARY CONTACT: 0 OWNER .. c.CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: r,. ‘111-1L �1. CONTACT PHONE: 441,s— v <br /> CONTACT EMAIL: J/� <br /> t /DAlC�L( Aiaxy'i_-c.-NASA'-com <br /> AGREEMENT:I 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 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 I 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 /> PERMIT# <br /> o-L3��� E k9-(0 - [, (0 <br /> Owner/Authorized 'gent S',nature Date (Revised 9/23/2016) <br />