11030 EVERGREEN WAY 2017-07-14 - Laserfiche WebLink

FI&ECTRICAL PERMIT AFOLICATION 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: 0 3 0 E of e fee n t4i E-Jerk 0)e 2,y BUILDING AREA(if residential,new construction,remodel,or addition) SF BUILDING TYPE: ❑ SFR-DETACHED ❑ SFR-ATTACHED ❑ DUPLEX MULTI-FAMILY-#OF UNITS:_q$I ❑ COMMERCIAL USE OF BUILDING: ELECTRICAL APPLICATION INFORMATION CONTRACT PRICE OF WORK: $ I'2r .r00 NUMBER OF DEVICES if low voltage): FIRE ALARM? ❑YES ❑ NO ASSOCIATED BUILDING PERMIT# if applicable): DESCRIPTION OF WORK: ( c f r{ 9 (� of And CONTACT INFORMATION OWNER NAME: An .f TENANT NAME If Commercial): OWNER MAILING ADDRESS: STREET C 6',), CITY Se/. Ole STATE VJA zIP ye111 OWNER PHONE: 2 o 6- 505 - g o oo OWNER EMAIL: uS °✓�ciS r✓�C i G til e �•c o,� CONTRACTOR NAME: t-Je-r (e n `- 4 CONTRACTOR ADDRESS: STREET /A D / CITY G ✓I�QA STATE tA /'T ZIP qQ Z(� CONTRACTOR PHONE: 3 bo -3o3- 6-79 G CONTRACTOR EMAIL: C h/,)' Q e Ver lee-, 1,'j ii,�, 4,? �f CONTRACTOR LIC.#(REQUIRED): ICITY OF EVERETT BUSINESS LIC.#(REQUIRED): PRIMARY CONTACT: ❑ OWNER VLCONTRACTOR ❑OTHER(Please Specify) CONTACT NAME: CONTACT PHONE: 3 6 0_ 3o s' 7 9 6 C ' S Chir �e-C CONTACT EMAIL: C li,C�S � eV�� 'f en 1: t. . /let 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 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 FEE A �-]I S_ PERMIT# _ E IIID - 14, Owner/Authorized Agent Signature Date (Revised 10/12/2015)