2802 VICTOR PL 2020-06-03 - Laserfiche WebLink

ECTRICAL PERMoT Ad UCAT ON ✓ :si, CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET, EVERETT, WA 98201 (P)425-257-8810 FAX 425-257-8857 I (E) everetteps@everettwa.gov www.everettwa.gov/permits • PROJECT SITE INFORGitlATII J N PROJECT ADDRESS: 21,0 r g(!eAr' BUILDING AREA(if residential, new construction,remodel, or addition) SF BUILDING TYPE: 0 SFR-DETACHED ❑SFR-ATTACHED ❑ DUPLEX ❑ MULTI-FAMILY-it OF UNITS: ❑ COMMERCIAL USE OF BUILDING: ELECTRICAL APPLICATION FORMA T I CONTRACT PRICE OF WORK: $ NUMBER OF DEVICES (if low voltage): FIRE ALARM? ❑YES ❑ NO ASSOCIATED BUILDING PERMIT#(if appli1 ble): 7 DESCRIPTION OF WORK: eIrI Q "49 or tri B6 (e• • CONTACT INFORMATION OWNER NAME: ttii&r- {'� 6(3. TENANT NAME(If Commercial): OWNER MAILING ADDRESS: STREET 192,0g cr Y .y/A/et/@ L¢ STATE ( 4GL ZIP ` iV S 6i OWNER PHONE: 'y. 3 t ®4 OWNER EMAIL: eth Cd. rJ pi5r? . aem CONTRACTOR NAME: CONTRACTOR ADDRESS: STREET CITY STATE ZIP CONTRACTOR PHONE: CONTRACTOR EMAIL: CONTRACTOR LIC.#(REQUIRED): CITY OF EVERETT BUSINESS LIC.#(REQUIRED): PRIMARY CONTACT: 0 OWNER 0 CONTRACTOR 0 OTHER(Please Specify) CONTACT NAME: CONTACT PHONE: CONTACT EMAIL: 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 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 4 PERMIT# AP. oq- Berle E \\,,G o9 -06 3 Owner • orize' ••-ntnature g Date (Revised 10/12/2015)