2111 ROSS AVE 2022-02-15 - Laserfiche WebLink

• • ELECTRICAL PERMIT APPLICATION re s// CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET, EVERETT,WA 98201 (P)425-257-8810 I FAX 425-257-8857 J (E)everetteps@everettwa.gov J www.everettwa.gov/permits PROJECT SITE INFORMATION PROJECT ADDRESS: Zit ( RI,65 4-'.i BUILDING AREA(If residential,new construction,remodel,or addition) SF BUILDING TYPE: ❑SFR-DETACHED ❑SFR-ATTACHED 0 DUPLEX 0 MULTI-FAMILY-#OF UNITS: %COMMERCIAL USE OF BUILDING: • • ELECTRICAL APPLICATION INFORMATION CONTRACT PRICE OF WORK:$ _360, e90 NUMBER OF DEVICES(if low voltage): FIRE ALARM? ❑YES NO ASSOCIATED BUILDING PERMIT#(if applicable): DESCRIPTION OF WORK: CdtJI�C:�-i �C�CC�,U,t�� j�(ucAZ LA t -tit CONTACT INFORMATION • • • • OWNER NAME: (JAL)t.t, d 2 N STjZ(.eCZ€kJ TENANT NAME(If Commercial): OWNER MAILING ADDRESS: STREET jjI5 Z5 � t V" .A1 t2 t 115 p �J cfiy L.U(�.R ``C— STATE L.M ZIP" gzo OWNER PHONE:qz 2) 7/3 ` z8 f OWNER EMAIL: N/4 CONTRACTOR NAME: 0 -may c -tee Next- y. A� CONTRACTOR ADDRESS: STREET Si 0,e• UM-. j 1 ,- • CI1Y a' � STATE ZIP qn '( CONTRACTOR PHONE047.61 CONTRACTOR EMAIL: gQt.�( ,Q S5 kvet Wi1a CONTRACTOR LIC,#(REQUIRED): �2 5�2 ) CITY OF EVERETT BUSINESS LIC:#(REQUIRED):6611 iS- PRIMARY CONTACT: ❑OWNER IErCONTRACTOR ❑OTHER(Please Specify) CONTACT NAME: CONTACT PHONE: lFZ ,� 2 Z �� 4 �L(v <CA CONTACT EMAIL: ��w 55/17 AGREEMENT:/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 Sor./4 PERMIT# 6 � 9 E \ol0�r 012 Owner/Authorized Agent Signature Date (Revised 9/23/2016)