205 E CASINO RD 2016-10-03 - Laserfiche WebLink

(P) 425-257-8810 �ECTRICAL PERMIT A�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 INFORMATION PROJECT ADDRESS: � s � C J°G BUILDING AREA (if residential, new construction, remodel, or addition) SF BUILDING TYPE: ❑ SFR-DETACHED ❑ SFR-A�ACHED ❑ DUPLEX ❑ MULTI-FAMILY-#OF UNITS: � COMMERCIAL USE OF BUILDING: ELECTRICAL APPLICATION INFORMATION CONTRACT PRICE OF WORK: $ GO NUMBER OF DEVICES (if low voltage): FIRE ALARM? ❑ YES ❑ NO ASSOCIATED BUILDING PERMIT # (if applicable): DESCRIPTION OF WORK: J (� CONTACT INFORMATION OWNER NAME: D G U [�1___ L TENANT NAME (If Commercial): /�- L D D� OWNER MAILING ADDRESS: srRee-r d G pZO 4 CITY B Q L STATE (/�I ZIP J O� OWNER PHONE: p�s �,� OWNER EMAIL: %� }Zr 3 �Z P f � C4 CONTRACTOR NAME: J CONTRACTOR ADDRESS: sTREET �� B �� G~ �, GTY STATE � ZIP Q�J CONTRACTOR PHONE: � � CONTRACTOR EMAIL: CONTRACTOR LIC. #(REQUIRED): � L-� t ZL� CITY OF EVERETT BUSINESS LIC. #(REQUIRED): GI��! PRIMARY CONTACT: ❑ OWNER ❑ CONTRACTOR ❑ OTHER (Please Specify) CONTACT NAME: CONTACT PHONE: yJ� �� W �� t�rL�%�f (J CONTACT EMAIL: � " �� G,�4�C� AGREEMENT: T hereby certify that I have read and examined fhis application and know the same to be frue and correct. All provisions of laws and ordinances governing this fype of work will be complefed whether specified herein or not. The granting of a permit does not presume to give authonty fo violate or cancel the provisions of any other state or local law regulating consfrucfion or the performance of construction. That 1 am authorized by the owner of this property to perform the work for which application is made and 1 comply with the State Contractors Law 18.27 RCW and 296.200 WAC. orized Agent Signature Cify of Everett Otficial Use Only FEE � �' �- �� PERMIT # E u�� (Revised 10/12/2015)