3420 LOMBARD AVE 2016-08-08 - Laserfiche WebLink

03/21/2016 MON 15: 21 FAX 4252521666 CM Heating 1003/003 9LECTRICAL PERMIT APPLICATION 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 www.everettwa,gov/permits JgtsK is ;inu+{!n:'y� •: ,:��.,r" 'i 'i.; ;. .. PRp'JECT SITE INFORMATION. PROJECT ADDRESS.- BUILDING DDRESS:BUILDING AREA(If residential, new construction, remodel,or addlllon) SF BUILDING TYPE: Q SFR-DE=TACHED SFR-ATTACHED D DUPLEX ❑ MULTI-FAMILY-#OF UNITS: ❑ COMMERCIAL USE OF BUILDING: �/y4 th iiti} i��..al:lrµ)�b �Pyj;,r. :a,�,i, ;. •,b , I . s t �TRlwCQL:�pPPLlCAT10N 1NFoRmAS'ION: CONTRACT PRICE OF WORK: $ NUMBER OF DEVICES If low voltage):_ FIRE ALARM? ❑YES ❑ NO ASSOCIATED BUILDING PERMIT# If applicable): DESCRIPTION OF WORK; L a CONTACT INFORMATIQN OWNER NAME: TENANT NAME If Commercial): OWNER MAILING ADDRESS; srRF:ET CITYri STATE ZIP OWNER PHONE: J OWNER EMAIL: CONTRACTOR NAME; `` CONTRACTOR ADDRESS: STREET I CITY STAT ZIP CONTRACTOR PHONE: (� w -7CONTRACTOR EMAIL; Mi CONTRACTOR LIC,#REQUIRED / I dN CITY OF EVERETT BUSINESS LIC,#(REQUIRE ): PRIMARY CONTACT; ❑OWNER VCONTRACTOR ❑OTHER(Please Specify) C NTACT NAM : CONTACT PHONE: a J+f�_CA KQ� CONTACT FMAIL: Ar,PEEMENY'Thereby cartlfy that I have road and examinad this application and know the same to be true and correct. All provisions oflaws an rdrnanoes aovorning this type of work will be completed whether spacl/lad herein or not. The granting of a permit does not presume to give authority to violate or cancel the prov/dons of any other state or local law regulating aonstruotlon or the porformanoo of construction. that 1 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 16.27 ROW and 286.200 WAC. City of Everett Official Uae Only FEE PERMIT A �(a IlLe E Ownar/Authorized Agant Slghature Oate (Revised 1011212015)