1322 RUCKER AVE 2016-10-04 - Laserfiche WebLink

�.ECTRICAL PERMIT A�LICATION 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 PROJECTADDRESS: `�j�� f�j��,kL( fiVc'i , EU(��T BUILDING AREA (if residential, new construction, remodel, or addition)�� S� BUILDING TYPE: ❑ SFR-DETACHED ❑ SFR-AiTACHED ❑ DUPLEX ❑ MULTI-FAMILY -# OF UNITS: ❑ COMMERCIAL USE OF BUILDING: 11\�i ELECTRICAL APPLICATION INFORMATION CONTRACT PRICE OF WORK: $ O. UU NUMBER OF DEVICES (if low voltage): FIRE ALARM? ❑ YES NO ASSOCIATED BUILDING PERMIT # (if applicabie): DESCRIPTION OF WORK: � � -�'Uo; ��' v� �` `� �� vt-v�c �C�;� ('S � � —� � Yl 1 �--_-: . CONTACT INFORMATION OWNER NAME: �j;�� ,/� �, (1 TENANT NAME (If Commercial): OWNER MAILING ADDRESS: sTREET L�? Z— l,�L��-1 j'��(% CIN � \f [j(- � �� STATE ZIP � � -� I OWNER PHONE: OWNER EMAIL: CONTRACTOR NAME: — pl,t�'i � \�ci`+C �c%� \ � v�GC; _� CONTRACTOR ADDRESS: sTREer J 3 C% I,7 S CITY La, l�li S"i�(�j1/(%i�. STATE W.� ZIP V�,U ,� CONTRACTOR PHONE: ,�� — (� 13 CONTRACTOR EMAIL: CONTRACTOR LIC. #(REQUIRED): `� � t,� l S (�C � CITY OF EVERETT BUSINESS LIC. #(REQUIRED): i�J `T ��6� _ _ _ _ _.._. PRIMARY CONTACT: ❑ OWNER l�CONTRACTOR ❑ OTHER (Please Specify) ��^�—.<=�= -"� �c77� SC� CONTACT NAME: n 1 CONTACT PHONE: �Z5 ! L 3c..t _��j ��3 (� vtc:a,5 !t-14ti� SO CONTACT EMAIL: AGREEMENT: T hereby certify thaf 1 have read and examined ihis application and know the same to be true and correct. All provisions of laws and ordinances governing this type of work will be compleied whether specified herein or not. The granting of a permit does not presume to give authonty fo violate or cancel the p�ovisions of any othe� sfate or local law regulating construcfion or the performance of construction. That I am authorized by the owner of this property to perform fhe work for which applicafion is made and I comply wiih the State Contractors Law 98.27 RCW and 296.200 WAC. Owner/Authorized Agent Signature `' / Date City of Everett Offrcra/ Use Only FEE I () v�� `� l �" O i PERMIT # Ej�,D�-� � (Revised 10/12/2015)