5526 25TH AVE W 2016-10-17 - Laserfiche WebLink

�.ECTRICAL PERMIi AP LICATION CITY OF EVERETT PERMIT SE ICES 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: �� 1� ` � � �'� /rj1%�. � BUILDING AREA (if residential, new construction, remodel, or addition) SF BUILDING TYPE: �SFR-DETACHED ❑ SFR-ATTACHED ❑ DUPLEX ❑ MULTI-FAMILY-#OF UNITS: ❑ COMMERCIAL USE OF BUILDING: ��S i p�Y�7 �� ELECTRICAL APPLICATION INFORMATION CONTRACT PRICE OF WORK: $ 5��1 NUMBER OF DEVICES (if low voltage): FIRE ALARM? ❑ YES ❑ NO ASSOCIATED BUILDING PERMIT # (if applicable): DESCRIPTION OF WORK: l� .� D C. � R�-� ` 7 ��.- %-}� � CONTACT INFORMATION OWNER NAME: � �' G(�l- �/l% TENANT NAME (If Commercial): OWNER MAILING ADDRESS: srReeT j 40 "' .� �'J %�" U� w � v l� �G CITY � STATE ZIP OWNER PHONE: `" ,S" �$3 " SC�,S 3 OWNER EMAIL: CONTRACTOR NAME: CiV � rL� f��C,� CL�(_'T = l,�- CONTRACTOR ADDRESS: s-rREET �_ (�-- . v �' 1i�0 i`]� CIN � C.L ��t+L � STATE W� ZIP C �� CONTRACTOR PHONE: CONTRACTOR EMAIL: CONTRACTOR LIC. #(REQUIRED): �I�� LZ, I %�� CITY OF EVERETT BUSWESS LIC. #(REQUIRED): PRIMARY CONTACT: ❑ OWNER ❑ CONTRACTOR ❑ OTHER (Please Specify) CONTACT NAME: CONTACT PHONE: � � - � � � -- (� �,�5� �� rM CONTACT EMAIL: AGREEMENT: T hereby certify that 1 have read and examined this application and know the same to be true and correci. 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 authority to violate or cancel fhe provisions of any ofher state or local law regulating construction or fhe performance of construction. That 1 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/Authorized Agent Signature Date City of Evereit Official Use Only FEE �� PERMIT # E 160� � �33 (Revised 90/12/2095)