709 107TH PL SE 2016-09-15 - Laserfiche WebLink

WECTRICAL PERMIT A10LICATION 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: Q--1+h I C BUILDING AREA(if residential, new construction, remodel, or addition) SF BUILDING TYP"SFR-DETACHED ❑ SFR-ATTACHED ❑ DUPLEX ❑ MULTI-FAMILY-#OF UNITS: ❑ COMMERCIAL USE OF BUILDING: 1-AOm�C ELECTRICAL APPLICATION INFORMATION CONTRACT PRICE OF WORK: $ N I )1 NUMBER OF DEVICES (if low voltage): N A FIRE ALARM? ❑ YES NO ASSOCIATED BUILDING PERMIT#(if applicable): ? DESCRIPTION OF WORK: (Z EQ 13o X a''2-1j;-yP-- (Z v'1 VL;6 Fia'o M Tax�C� C) rn ra CONTACT INFORMATION OWNER NAME: �' l- '�A►'L 1z- TENANT NAME(If Commercial): OWNER MAILING ADDRESS: STREET S m CITY STATE ZIP OWNER PHONE: ' OWNER EMAIL: N CONTRACTOR NAME: CONTRACTOR ADDRESS: STREET CITY STATE ZIP CONTRACTOR PHONE: `Z-01�'�--7~?tel- )S CONTRACTOR EMAIL: i ril - �t `j L;1 r1S lloo:L CONTRACTOR LIC.#(REQUIRED):t-rC) 1'3-G5 e 71�a 23YZ CITY OF EVERETT BUSINESS LIC.#(REQUIRED): PRIMARY CONTACT: ❑ OWNER aCONTRACTOR ❑ OTHER(Please Specify) CONTACT NAME: \ , CONTACT PHONE: '7 q (o -?--)I 1 SI1, CONTACT EMAIL: YY) v-CS C 'o AGREEMENT.'T hereby certify that I have read and examined this application and know the same to be true and correct. All provisions of laws#d ordinances goveming 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/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 n �� Dy PERMIT# z-IZ7 Owner/ thorized Agent Signature Date (Revised 10/1212015)