Laserfiche WebLink
03/24/2016 THU 10: 54 FAX 4252521666 CM Heating 1003/003 <br /> 4E77 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 1 (E) everetteps@everettwa.gov www.everettwa.gov/perrttfts <br /> ;;!,• l ,3'i,',i `.1 ;.;a„;;Iii” ',v t;rr:.,;:. ^;•,. PROJECT SITE <br /> • yf ,,� IC y hr,rat'_,3�r<i, - INFORMATION • <br /> PROJECT ADDRESS: 3O S <br /> BUILDING AREA(If residential, new construction, remodel, or addition) SF <br /> BUILDING TYPE: 0 SFR-DETACHED y,2 SFR-ATTACHED 0 DUPLEX 0 MULTI-FAMILY-#OF UNITS: 0 COMMERCIAL <br /> USE OF BUILDING: <br /> ;'.f 10C T RICAL Api.LICATION,'INFORh/AT!Oh11'I <i"; :' <br /> CONTRACT PRICE OF WORK: $� <br /> NUMBER OF DEVICES (If low voltage), <br /> FIRE ALARM? 0 YES 0 NO <br /> ASSOCIATED BUILDING PERMIT# (if aePlicable): ^ <br /> DESCRIPTION OF WORK: <br /> _ k GLS- P(-Q 4 <br /> '+lisvf1R5.1y i;�,).6..'a�kt'1+�lt;c:,^n,��;;�,�,;;�,,,h :,;r;1' r.. CONTACT INFORMATION. .. <br /> l�t�>7:1F: •;�ti'k.LY��'. �<<1�:,�;������- rr vq,�Y4.�3�l.: ' • 1 •1�,' , <br /> OWNER NAME: r; <br /> A ,11. , TENANT NAME If Commercial : <br /> OWNER MAILING ADDRESS: REST ?0), GZ I sr <br /> � (�CITY STATE •�•'r� YIP <br /> OWNER PHONE; b4pcY OWNER EMAIL: <br /> C <br /> CONTRACTOR NAME: <br /> CONTRACTOR ADDRESS: DTREET I 5P.1J ad <br /> cir CTAT- _• ZIP 1 <br /> ! <br /> CONTRACTOR PHONE; 1� rn, O550 -�CONTRACTOR EMAIL: tQ ' J h,X 2t7 <br /> CONTRACTOR LIC.#(REQUIRED)IJ I�j 'V 7 ICYI` CITY OF EVERETT BUSINESS LIG.ft(REQUIRE : )'oq <br /> PRIMARY CONTACT: ❑ OWNER CONTRACTOR 0 OTHER(Please Specify) - <br /> NTACT NAM crn <br /> CONTACT PFIONE:L- 5 35q D <br /> -! <br /> 11�{,1 I�i Q CONTACT EMAIL: .ee) a .aj 4 'wr F, <br /> AGREEMENT:T hereby certify that I have reed end examined this application end know the same to be true and correct. All provisions of laws anitrdlnences governing this <br /> type of work will be completed whether specified herein or not. The granting of a permit does not presume to glue authority to violate or cancel the provisions of any other state or <br /> local law regulating construction or the performance of oonstruorion. That I am authorized by the owner of this property to perform the work for which application Is made end 1 <br /> comply with the State Contractors Law 18.27 ROW and 208.200 WAC, <br /> cityof Everett Official()so Only <br /> FEE "�] <br /> 15,0 <br /> PERMIT# <br /> ,AdiatA "1/ <br /> EiEbo <br /> Owner/Authorized Agent Signature Cale (Rovlsed?0/12'2015) <br />