Laserfiche WebLink
*ECTRICAL PERMIT AI6LICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> (P)425-257-8810 1 FAX 425-257-8857 1 (E) everetteps@everettwa.gov I www.everettwa.gov/permits <br /> PROJECT SITE INFORMATION <br /> PROJECT ADDRESS: 13 SE (r�GPGr� r tkm 5t'201 <br /> BUILDING AREA(if residential, new construction, remodel,or addition) SF <br /> BUILDING TYPE: ❑ SFR-DETACHED ❑ SFR-ATTACHED ❑ DUPLEX ❑ MULTI-FAMILY-#OF UNITS: ❑ COMMERCIAL <br /> USE OF BUILDING: •AC' (--C <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK: $ ( c)o :kn? <br /> NUMBER OF DEVICES (if low voltage): <br /> FIRE ALARM? ❑YES ❑ NO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIPTION OF WORK: -I SIr� r rnG c .�c Y vz�f'l�� `4- <br /> o S kk'OA ( - t-ow� D� D } +�8 /�� x�c o� <br /> Co mAo tsar u ` c A c <br /> CONTACT INFORMATION <br /> OWNER NAME: �rc��Q�.�c L iZ� "��( Aed Com,( TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET <br /> CITY STATE ZIP <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: Vr CA le-c+-rf'L- <br /> CONTRACTOR ADDRESS: STREET PLO /� �y <br /> CITY �CLi'f•'['l 1, STATE iO4 ZIP 4si0o <br /> CONTRACTOR PHONE: b(a_z13&-S Z6C> CONTRACTOR EMAIL: <br /> CONTRACTOR LIC.#(REQUIRED): V*—bA r--C--C: 5 y Z MV CITY OF EVERETT BUSINESS LIC.#(REQUIRED): <br /> PRIMARY CONTACT: ❑ OWNER 9CONTRACTOR ❑ OTHER(Please Specify) <br /> CONTACT NAME: 0 CONTACT PHONE: ZG(o- 615-0- ' 539 <br /> 'Stn-_'0)qJ cloe"I w6(d CONTACT EMAIL: ` CA <br /> AGREEMENT:Thereby 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 <br /> type of work will be completed whether specified herein or not. The granting of a permit does not presume to give authority to violate or cancel the provisions of any other state or <br /> local law regulating construction or the performance of construction. That/am authorized by the owner of this property to perform the work for which application is made and I <br /> comply with the State Contractors Law 18.27 RCW and 296.200 WAC. <br /> City of Everett Official Use Only <br /> FEE <br /> too <br /> PERMIT# <br /> 7 <br /> 7_11S& E <br /> O er/Authoriz d Agent Signature Date (Revised 10/12/2015) <br />