2107 ROCKEFELLER AVE 2016-10-04 - Laserfiche WebLink

�,�►� �� �ECTRICAL PERMIT AP�ICATION CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET, EVERETT, WA 98201 (P) 425-257-8810 � FAX 425-257-8857 �(E) everetteps@everettwa.gov � www.everettwa.gov/permits PROJECT SITE INFORMATION ��? �,. PROJECT ADDRESS: � �� _.�„�l'�,. ��rZ_ � ��G�- � � . L�� `_ �f1 r, O / / C � ��tY �SL.'�� BUILDING AREA (if residential, new construction, remodel, or addition) — SF BUILDINGTYPE: FR-DETACHED SFR-ATTACHED ❑ DUPLEX ❑ MULTI-FAMILY-#OF UNITS: ❑ COMMERCIAL USE OF BUILDING: CONTACT INFORMATION � ' ��Z,', TENANT NAME (If Commercial): OWNER NAME: ,� OWNER MAILING ADDRESS: sTREET ��07 ��✓�.� G��'. �� cirv � G'r/1_.%— sTnTE �/s�' ziP � � OWNER PHONE: �. 5" T';�� <<�C' OWNER EMAIL: �j9'J�� CONTRACTOR NAME: ' � �'i �-e'--�- / c.�/G CONTRACTOR ADDRESS: srREEr � C � �'%j �- � � � CITY ��/,��" L/� STATE � �� ZIP ".�� CONTRACTOR PHONE: CONTRACTOR EMAIL: CONTRACTOR LIC. #(REQUIRED): u,�, I� �L C��5 l�� CITY OF EVERETT BUSINESS LIC. #(REQUIRED).Or ��Ci � PRIMARY CONTACT: ❑ OWNER � CONTRACTOR ❑ OTHER (Please Specify) CONTACT NAME: j�. ��f�f�%� CONTACT PHONE: �,� —�.�"�-� ��-r—.ly� CONTACT EMAIL: AGREEMENT: T hereby certify that I have �ead and examined this application and know the same to be true and correct. All provisions of laws and o�dinances 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 o� cancel the provisions of any other state or local law regulating construcfion or the performance of construction. That I 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. Owner/AiiitNorized Aqent Slqnature �-� Date � City of Everett Official Use Only FEE .�� D�� PERMIT # E ��-- �� (Revised 10/12/2015)