602 102ND PL SE 2016-09-15 - Laserfiche WebLink

• • ELECTRICAL PERMIT APPLICATION CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET, EVERETT, WA 98201 (P)425-257-8810 J FAX 425-257-8857 ( (E) everetteps@everettwa.gov I www.everettwa.gov/permits PROJECT SITE INFORMATION PROJECTADDRESS: Z 1 02—)l �A j! 1 -T I BUILDING AREA(if residential,new construction,remodel,or addition) SF BUILDING TYPE: ❑SFR-DETACHED N SFR-ATTACHED ❑ DUPLEX ❑MULTI-FAMILY-#OF UNITS: L7 COMMERCIAL USE OF BUILDING: ELECTRICAL APPLICATION INFORMATION CONTRACT PRICE OF WORK:$ 150 NUMBER OF DEVICES if low voltage): FIRE ALARM? ©YES 11 NO ASSOCIATED BUILDING PERMIT# if applicable): DESCRIPTION OF WORK: CONTACT INFORMATION OWNER NAME: (V TENANT NAME(if Commercial): OWNER MAILING ADDRESS: UREU My}+, ` I STATE Zip OWNER PHONE: ! !-! OWNER EMAIL: CONTRACTOR NAME: G ro CONTRACTOR ADDRESS: STREET tiLs Y'badwotq CnY Eve f SLATE W A Zip 4 2.01 CONTRACTOR PHONE:q 2 40&(p CONTRACTOR EMAIL: debbie D cmWeA4tiri . coM CONTRACTOR LIC.#(REQUIRED): In N 2-11 DN N CITY OF EVERETT BUSINESS LIC.#{REQUIRED: PRIMARY CONTACT: O OWNER A CONTRACTOR ❑OTHER(Please Specify) — CONTACT NAME: CONTACT PHONE: 425 0,quers CONTACT EMAIL: cm he Odin .r-by- E AOREEM1rNT:Thereby car8ty that t have read and examined this application and know the same to be true and correct. All provislons of laws and ordinances governing this type of work wtfl ba completed whelherspecifred herein ornot. rho granting of a permit does not prnsume to give authority to violate or cancel the provisions of any other state or local law regulating construction or the performance of constm,:tion. Thal l am suthortzed by the owner of this property to perform the work rorwh!ch appl;canon is made and f comply with the State Contractors Law 16,27 RCW and 298.200 WAC. City of Everett Officlat Use Only FEE PERMIT# - OwnorlAuthorized A of Signature Dato (Revised 101122016)