923 51ST PL SW 2016-06-03 - Laserfiche WebLink

ELECTRICAL PERMIT APPLICATION (gn-- CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET, EVERETT, WA 98201 (P)425-257-8810 1 FAX 425-257-8857 1 (E)everetteps@everettwa.gov I www.everettwa.gov/permits PROJECT SITE INFORMATION:. PROJECT ADDRESS: `77:3 -- 51 5 t- 0/A CO �S BUILDING AREA(if residential,new construction,remodel,or addition) SF BUILDING TYPE: FA SFR-DETACHED ❑SFR-ATTACHED 0 DUPLEX 0 MULTI-FAMILY-'I!OF UNITS: 0 COMMERCIAL USE OF BUILDING: ELECTRICAL APPLICATION INFORMATION CONTRACT PRICE OF WORK:$ 500, NUMBER OF DEVICES(if low voltage): FIRE ALARM? 0 YES 0 NO ASSOCIATED BUILDING PERMIT#(if applicable): DESCRIPTION OF WORK: AthiIvt-U1 6/!LC,iiT 'Wt7<.)1_r7 (/t2(uir FOR 'lv 141(7 FI!�it-'OJ iZ CONTACT INFORMATION OWNER NAME: (,/AC i7 gRA/ %Z TENANT NAME(If Commercial): OWNER MAILING ADDRESS: smear '1 Z3 61s7-i-/nec 56.). /' cn6%1/ 522P-77— y STATE (/(/,q. ZIP CI Zi.7g OWNER PHONI 4Z0 3'74-- 367f-! OWNER EMAIL:/ f,4 PLITVZr Vi/ 7 n/ o'V14i/ ' CONTRACTOR NAME: 61/2./42e—eAJ O7m✓9%ff /r T A C— CONTRACTOR ADDRESS: STREET Z I it7 CITY .0 ue-/zr j STATE1.4)4 ZIP _1i(20/ CONTRACTOR PHONE: (4 Z.�) Z — ?,// / CONTRACTOR EMAIL: CONTRACTOR LIC.#(REQUIRED): &71/e."45SOZZ OT CITY OF EVERETT BUSINESS LIC.#(REQUIRED):-7 755 PRIMARY CONTACT: ❑OWNER ciCCONTRACTOR 0 OTHER(Please Specify) CONTACT NAME: CONTACT PHONE: (V.S"J7�Z.—3 0/p- � CONTACT EMAIL: Q l26,-).4) j.i41./ C aprt AGREEMENT T hereby certify that 1 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 1 am authorized by the owner of this property to perforin the work for which application is made and I comply with the State Contractors Law 18.27 RCW and 298.200 WAC. City of Everett Official Use Only FEE 131 0 _-" PERMIT# gt;t4) UP)--- 1 Owner/Aut orized Agent Signature Date (Revised 10/12/2015)