1108 GRAND AVE 2016-08-22 - Laserfiche WebLink

EfECTRICAIL PERMIT APWICATION 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: 111)o Dord d kv-e IF—V eKe+ I W p '�00ZD I _ BUILDING AREA(if residential, new construction, remodel, or addition) YVS �Pi tla SF BUILDING TYPE: ❑ SFR-DETACHED SFR-ATTACHED ❑ DUPLEX ❑ MULTI-FAMILY-#OF UNITS: ❑ COMMERCIAL USE OF BUILDING: ELECTRICAL APPLICATION INFORMATION CONTRACT PRICE OF WORK: $ T3D NUMBER OF DEVICES (if low voltage): FIRE ALARM? ❑ YES m NO ASSOCIATED BUILDING PERMIT# (if applicable): DESCRIPTION OF WORK: I. 1ns+aA[ SuOlW Z• Q10U YYI6,I(1 urw� �J• ( M 1 A-v� ) no SO �ODYVI I m i lCONTACT INFORMATION OWNER NAME: L�s�)Q QQN Q } /n TENANT NAME(If Commercial): OWNER MAILING ADDRESS: STREET ` Voo b��1 �,I T Y e � CITY 'Y*I pAt �(y"STATE 1 ZIP 01 C ZD, OWNER PHONE: ( gas ) 2J4-3J 2�Uo OWNER EMAIL: ISI l CONTRACTOR NAME: )� �USp IFIOYIN SerylCQs CONTRACTOR ADDRESS: STREET 19/ OIyyl r-M Dy' � CITY I/VI✓� S rl v I STATE CONTRACTOR PHONE: U�S� 2 D { CONTRACTOR EMAIL: I LAC(AS S CONTRACTOR LIC.#(REQUIRED): InhOl�1 Q S�52uC� CITY OF EVERETT BUSINESS LIC.#(REQUIRED): q I LO PRIMARY CONTACT: ❑ OWNER CONTRACTOR OTHER(Please Specify) '�-e CONTACT NNA,MP:: CONTAC1 PHONE: CONTACTEMAIL: � AGREEMENT.Thereby certify that I have read and examined this application and know the same to be true and correct. All provisi ns 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 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 PERMIT# E till OWnerIA horized g Signature Date (Revised 10/12/2015) I it