1217 LOMBARD AVE B 2020-07-14 - Laserfiche WebLink

ELECTRICAL PERMIT APi3LICATION ,iirifri --- CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET, EVERETT, WA 98201 (P)425-257-8810 I FAX 425-257-8857 1 (E) everetteps@everettwa.gov l www.everettwa.gov/permits PROJECT SITE INFORMATION PROJECT ADDRESS: 2,/9z Jo t44QY/{ ig ti.e._( , -1A-/-e--74-7— GJ19 ff2e) 111 BUILDING ARE. if res':ential, ,ew construction,remodel,or addition) SF BUILDING TY•-• ■ . --DETACHED 0 SFR-ATTACHED `0 DUPLEX 0 MULTI-FAMILY-#OF UNITS: 0 COMMERCIAL USE OF BUILDING: :r 2 IGATION INFORMA77O$ CONTRACT PRICE OF W •K:$ ,. NUMBER OF DEVICES(if to , vUt Qb); FIRE ALARM? ,YES 0 NO ASSOCIATED BUILDING PERMIT#(if applicable): . DESCRIPTION OF WORK: C ,l _,wviCto AP'.., ,,,/ �O �-��' / ,�./�e i G, )7 d k k)e......jz.ilik, '‘'ke=t1-;tirAT - cc-.)E Q t f\Sl. Ar•---.. CONTACT INFORMATION. .: . • OWNER NAME: 616'` e.,_ ��,---74er-z_____ TENANT NAME(If Commercial): OWNER MAILING ADDRESS: STREET / 1--.44. ‘1-/c .7/e. . �d� &- CITY /� STATE Ce/ ZIP 7' , / OWNER PHONE: - y. , O. OWNER EMAIL:,(" ry. ,P,k1v.?-a,Q__P t,,.Q ,. ,. .. /\ CONTRACTOR NAME: CONTRACTOR ADDRESS: STREET . CITY STATE ZIP 'CONTRACTOR PHONE: CONTRACTOR EMAIL: ' CONTRACTOR LIC,#(REQUIRED): CITY OF EVERETT BUSINESS LIC.#(REQUIRED): y ' 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!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 CLO K.; '-(4,` .._- �_,512 CJ FEE (CC ---- PERMIT# 001-4 7/4160ft '''7,1-jg le"L-r/Au.lhorized Agent Signature Date (Revised 10/12/2015)