1611 RUCKER AVE 2016-08-30 - Laserfiche WebLink

�ECTRICAL PERMIT AF�ICATION CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET, EVERETT, WA 98201 (P) 425-257-8810 � FAX 425-257-8857 �(E) everetteps@everettwa.gov � www.everettwa.gov/permits ELECTRICAL APPLICATION INFORMATION CONTRACT PRICE OF WORK: $� ��. NUMBER OF DEVICES if low volta e: FIRE ALARM? ❑ YES ❑ NO ASSOCIATED BUILDING PERMIT # if a licable : DESCRIPTION OF WORK: `(V��w O �j — . �� ITEIL Er'ol�R� 2$O HE Mc�put,�S Ot� �vc� 1 (�K- �N�'R�, �/15200 9�_ S�- ►�1 t� �i� CONTACT INPORMATION OWNER NAME: ��e1 �-�� .-6% �� TENANT NAME (If Commercial): P'\ 6�,r OWNER MAILING ADDRESS: sTReEr � �' d22UC1�-�� AY� CITY �v`�� STATE Vv/'� ZIP `I O L�� OWNERPHONE ��L.S 2.5�= �905 OWNEREMAIL: ��rtd�l'�(lSl�i. CO CONTRACTOR NAME: �E.ST�(Z(� �(�� 4�� CONTRACTOR ADDRESS: sTReeT �{ Qy , pfV� �� S� CITY ��l�V� � C� q i�� V� STATE �/ �+��0, ZIP ��Z� CONTRACTORPHONE: (Db %��—��5� CONTRACTOREMAIL: �N��We.Si�..YrISo�GLr'a�'l�. c71'V� CONTRACTOR LIC. #(REQUIRED): �N�S�t.S �$�� i� CITY OF EVERETT BUSINESS LIC. #(REQUIRED): C7 �J� ( S'�j PRIMARY CONTACT: ❑ OWNER �CONTRACTOR ❑ OTHER (Please Specify) CONTACT NAME: CONTACT PHONE: ?��j� �Q-( � � ��j� �-�� 1 �� CONTACT EMAIL: �a-� � � �S � � �. o i1G, AGREEMENT: T hereby certify that I have read and examined this application and know the same fo 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 fo 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. Signature �+ �s� a� Date City of Everett Otficial Use Only FEE � �� PERMIT # E �- �L �� `� �% (Revised 10/12/2015)