1422 COLBY AVE 2016-09-20 - Laserfiche WebLink

(P) 425-257-8810 E�CTRICAL PERMIT AP� ICATION CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET, EVERETT, WA 98201 FAX 425-257-8857 �(E) everetteps@everettwa.gov � www.everettwa.gov/permits PROJECT SITE iNFORMATIt�N PROJECT ADDRESS: I"l2Z V e VV•C/ �1 " 1�%D I 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: ,Pj� 1�� {�1 � (�i ELECTRICAL APPLICATION INFORMATION CONTRACT PRICE OF WORK: $ �� NUMBER OF DEVICES if low volta e: FIRE ALARM? ❑ YES NO ASSOCIATED BUILDING PERMIT # if applicable : DESCRIPTION OF WORK: ,� �n �-�J'�� I�� G//�l/�! �-�"Y �lGt C�"L�5-S �� CONTACT INFORMQTION OWNER NAME: �iQ �/�% TENANT NAME (If Commercial): OWNER MAILING ADDRESS: sTREEr � LI ZZ �✓ �"1 ✓� CITY �v /J STATE �� ZIP • v'� / OWNER PHONE: �2 ��Z2 - S%y OWNER EMAIL: �v�� CONTRACTOR NAME: �{'j !Ta"v(� �-e(1�i�1 C� �-ei'V1G�.s� �%I G- CONTRACTOR ADDRESS: sTREET I�3O �17��'1 ,�� g�i CITY �/!`''L� i:��r i/Y l,s STATE � ZIP //��% CONTRACTOR PHONE: yZ�J D^ 2� CONTRACTOR EMAIL: C{ S I i�I .7L-�I�V6� ��' CONTRACTOR LIC. #(REQUIRED): I N H� ��S !�2- QG CITY OF EVERETT BUSINESS LIC. #(REQUIRED): Q�Iy��S PRIMARY CONTACT: ❑ OWNER CONTRACTOR ❑ OTHER (Please Specify) CONTACT NAME: �/� D� CONTACT PHONE: �LP�-�j� y yZS 7(�O �Z� �� CONTACT EMAIL: C��s-� Y,��/y �,S G� %�JOL�� '�� AGREEMENT: T hereby certify that I have read and examined this application and know the same to be true and correct. All provisions of ws 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 vio/ate 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 propeRy to perform the work for which application is made and 1 comp/y with the State Contractors Law 18.27 RCW and 296.200 WAC. �/! Z// (p � Owner/AutFy¢fized Agent Signature // ` v � Date City of Everett Official Use Only FEE �'� � _ PERMIT # E �.� �� -�- � \ �� (Revised 10/12/2015)