719 OLYMPIC BLVD 2016-10-04 - Laserfiche WebLink

(P) 425-257-8810 PROJECT ADDRESS: r%% Y � �ECTRICAL 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 INFORMATION � / BUILDING AREA (if residential, new constr ction, remodel, or addition) ��080 SF BUILDING TYPE SE OF BUILDING: ��. v 3 FR-DETACHED �SFR-ATTACHED ❑ DUPLEX ❑ MULTI-FAMILY-# OF UNITS: ❑ COMMERCIAL ELECTRICAL APPLICATION INFORMATION CONTRACT PRICE OF WORK: $ NUMBER OF DEVICES (if low voitage): � FIRE ALARM? ❑ YES ❑ NO ASSOCIATED BUILDING PERMIT # (if applicable): DESCRIPTION OF WORK: � Q� F �� CONTACT INFORMATION OWNER NAME: ,��^i G � rp TENANT NAME (If Commercial): OWNER MAILING ADDRESS: srREET � ��C ��n r v r#�" STATE wf� Z�P 8ac� OWNER PHONE: ��iZS' yy— D`� S� OWNER EMAIL: � S R li � GC� CONTRACTOR NAME: ��,,� e r CONTRACTOR ADDRESS: srReEr CITY STATE ZIP CONTRACTOR PHONE: CONTRACTOR EMAIL: CONTRACTOR LIC. #(REQUIRED): CITY OF EVERETT BUSINESS LIC. #(REQUIRED): PRIMARY CONTACT: ❑ OWNER ❑ CONTRACTOR ❑ OTHER (Please Specify) CONTACT NAME: CONTACT PHONE: CONTACT EMAIL: AGREEMENT: T hereby certify that / have read and examined this application and know the same to be true and correct. All provisions of laws 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 authonty to violate or cance/ the provisions of any other state or local law regu/ating construction or the performance of construction. That I am authorized by the owner of this property to pertorm the work for which application is made and 1 comply with the State Contractors Law 18.27 RCW and 296.200 WAC. City of Everett Official Use Only FEE _l �_ �= F- PERMIT # E i�r�l�fl`I (Revised 10/12/2015)