4514 GRAND AVE 2016-08-22 - Laserfiche WebLink

WECTRICAL PERMIT A f LICATION CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET, EVERETT, WA 98201 (P)425-257-8810 1 FAX 425-257-8857 j (E) everetteps@everettwa.gov I www.everettwa.gov/permits PROJECT SITE INFORMATION PROJECT ADDRESS: 5 I u9 A BUILDING AREA(if residential, new construction, remodel, or addition) SF BUILDING TYPE: ❑ SFR-DETACHED ❑ SFR-ATTACHED ❑ DUPLEX ❑ MULTI-FAMILY-#OF UNITS: ❑ COMMERCIAL USE OF BUILDING: 12 e 5 ,J "C: ELECTRICAL APPLICATION INFORMATION CONTRACT PRICE OF WORK: $ goo NUMBER OF DEVICES (if low voltage): FIRE ALARM? ❑YES 21NO ASSOCIATED BUILDING PERMIT# (if applicable): DESCRIPTION OF WORK: CONTACT INFORMATION OWNER NAME: e_ +n C TENANT NAME(If Commercial): OWNER MAILING ADDRESS: STREET I l l� S_ l ►;- }'b. v\c'�' �7 CITY y� Lli`C1C STATE T y� ZIP OWNER PHONE: S 3'�— ( 7 OWNER EMAIL: (,_ecw\i j S e IE', CONTRACTOR NAME: I'c CONTRACTOR ADDRESS: STREET CITY \��E' V+'C. STATE ZIP CONTRACTOR PHONE: 5 L `7 I O 6 jf CONTRACTOR EMAIL: ( 1 c� Y� lr' ` ✓" r CONTRACTOR LIC.#(REQUIRED): Ij E IDS C– Q "J C Cip CITY OF EVERETT BUSINESS LIC.#(REQUIRED): PRIMARY CONTACT: ❑ OWNER CONTRACTOR ❑ OTHER(Please Specify) CONTACT NAME: CONTACTPHONE: -7I _.0(� 1 I CONTACT EMAIL: AGREEMENT.'T hereby certify that 1 have read and examined this application and know the same to be true a d correct. All provisions o aws 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# Owner/Authorized Agent Signature Date (Revised 10/1212015)