Laserfiche WebLink
�.ECTRICAL PERMIT A�LICAT'ION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />(P) 425-257-8810 � FAX 425-257-8857 �(E) everetteps@everettwa.gov � www.everettwa.gov/permits <br />PROJECT SITE INFORMATION <br />� J- � <br />PROJECT ADDRESS: �' �,�.� j �� j/i N �^ ;9 <br />BUILDING AREA (if residential, new construction, remodel, or addition) SF <br />BUILDING TYPE: ❑ SFR-DETACHED [7 SFR-ATfACHED ❑ DUPLEX ❑ MULTI-FAMILY -# OF UNITS: ❑ COMMERCIAL <br />USE OF BUILDING: < ��,,�. � jq;�;� <br />ELECTRICAL APPLICATION INFORMATION <br />CONTRACT PRICE OF WORK: $ �,���? �" <br />NUMBER OF DEVICES (if low voltage): <br />FIRE ALARM? ❑ YES � NO <br />ASSOCIATED BUILDING PERMIT # (if applicable): <br />DESCRIPTION OF WORK: �� 5 !� ����� -� � ' ( n�� � � - � <br />CONTACT INFORMATION <br />OWNER NAME: Tj�� /rje f GlF ,� TENANT NAME (If Commercial): <br />OWNER MAILING ADDRESS: srRee-r C 7 �j � �� C'd "- y` <br />CITY /" . � ��^(� ��� STATE - G 'C/' . ZIP � ��L � S <br />OWNER PHONE: 4'�.� � — l' � � — � � � OWNER EMAIL: <br />CONTRACTOR NAME: ���� '� - -• � ;� E=' � <br />CONTRACTOR ADDRESS: srREEr � `� �% �� =' � � l�� <br />i' <br />CITY � � /J� "�f`7 .� f STATE �� �� ZIP '� �.��� � �� <br />CONTRACTOR PHONE: CONTRACTOR EMAIL• C�o. c -; t: <<' �� %��a-r ,. � <br />� <br />CONTRACTOR LIC. #(REQUIRED): V �'V' ' �` l�" ?� �-' � l5'�� CITY OF EVERETT BUSINESS LIC. #(REQUIRED): �'?,? ' � <br />_ <br />PRIMARY CONTACT: 0' OWNER [,$'CONTRACTOR ❑ OTHER (Please Specify) <br />CONTACT NAME: CONTACT PHONE: ��,> �� - - � � L%_ �% �',;� �� <br />i' �' �� �r� ` � .n �� CONTACT EMAIL: <br />AGREEMENT: T herebvi certifv that I have read and examined this application and know the same to be true and correct. All provisions of laws and ordinances qoverninq this <br />type of work will be completed whether specified herein or not. The granting of a permit does not presume fo grve authonty to violate or cancel the provisions of any other sfate or <br />local law �egulating construction or the performance of construction. That 1 am authorized by ihe owner of this property fo perform the work for whic% application is made and 1 <br />comply wifh the State Contractors Law 18.27 RCW and 296.200 WAC. <br />�, <br />� �, ;;; <br />� ; ���,� <br />��� ` <br />Owner/Authorized Agent Signature <br />Date <br />City of Everett Official Use Only <br />FEE <br />� ��, �G� <br />PERMIT # <br />E � <br />(Revised 90/12/2 15) <br />