1005 RUCKER AVE 2016-10-06 - Laserfiche WebLink

i.ECTRICAL PERMIT Af�L.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: �, vd S � � �' /t�f "�. BUILDING AREA (if residential, new construction, remodel, or addition) i� S i��h+i c� SF BUILDING TYPE: ❑ SFR-DETACHED ❑ SFR-A�ACHED ❑ DUPLEX ❑ MULTI-FAMILY-# OF UNITS: ❑ COMMERCIAL � � USE OF BUILDING: t U 1,/� ' ELECTRICAL APPLICATION INFORMATION CONTRACT PRICE OF WORK: $ ) ` NUMBER OF DEVICES (if low voltage): FIRE ALARM? ❑ YES �NO ASSOCIATED BUILDING PERMIT # (if applicable): DESCRIPTION OF WORK: ;��,n 'r ��-' CONTACT INFORMATION OWNER NAME: S-G',c�, �� TENANT NAME (If Commercial): OWNER MAILING ADDRESS: sTREeT �U �j � k�� ,�QU� CITY � l�v� ��[ STATE �W ! 1 ZIP OWNER PHONE: OWNER EMAIL: CONTRACTOR NAME: - � I " "T��;G� CONTRACTOR ADDRESS: sTREET ,�3� � I ' �J� S� CITY ��v �,��J(�� STATE v" +A ZIP � C.� ZS CONTRACTOR PHONE: • �� — � � � CONTRACTOR EMAIL: CONTRACTOR LIC. #(REG2UIRED): '1'\Yl -' S G1 SL�(j1 � CITY OF EVERETT BUSINESS LIC. #(REQUIRED): G'�� ,�b PRIMARY CONTACT: ❑ OWNER ,L�,CONTRACTOR ❑ OTHER (Please Specify) CONTACT NAME: ��5 � lU�� p CONTACT PHONE: �-��j _23 _�� 1 CONTACT EMAIL: AGREEMENT: T hereby certify that I have read and examined fhis application and know the same fo be true and correct. All provrsions oflaws and ordinances governing this type of work will 6e completed whether specified herein or not. The granting of a permit does not p�esume to give authori(y to violate or cancel the provisions of any other state or local law regulating construction or the performance of construction. That I am aufhorized by the owner of fhis property to perform the work for which application is made and 1 comply v✓ifh the State Contractors Law 18.27 RCW and 296.200 WAC. Owner/Authorized Agent Signature City of Eve�ett Official Use Only FEE �� PERMIT # E Q � � B-�� (Revised 10/12/2015)