1427 122ND ST SE 2016-10-26 - Laserfiche WebLink

�ECTRICAL PERMIT A�LICAiION 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: I'7 L� IZ��j � ry�^ S�� /�E'�T `'�/r �r�i� ^ BUILDING AREA (if residential, new construction, remodel; or addition) 2-C%Z7v SF BUILDING TYPE: ❑ SFR-DETACHED �.SFR-ATTACHED ❑ DUPLEX ❑ MULTI-FAMILY -# OF UNITS: ❑ COMMERCIAL USE OF BUILDING: ��.Z( (r�� /��J� 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: �� L � � �� .j,._ CONTACT INFORMATION OWNER NAME: �,C1Ul` (�OUC�NL/� TENANT NAME (If Commercial): OWNER MAILING ADDRESS: s�EEr ��2-� �2�0 ST S� CITY � /.�� I � � `� STATE �/q ZIP �( (J �C% OWNER PHONE: OWNER EMAIL: CONTRACTOR NAME: OC�✓(`�G� CONTRACTOR ADDRESS: sTReET CIIY STATE ZIP CONTRACTOR PHONE: CONTRACTOR EMAIL: CONTRACTOR LIC. #(REQUIRED): CITY OF EVERETT BUSINESS LIC. #(REQUIRED): PRIMARY CONTACT: ❑ OWNER ❑ CONTRACTOR ❑ OTHER (Please Specify) CONTACT NAME: CONTACT PHONE: CONTACT EMAIL: AGREEMENT: T hereby certify that 1 have read and examined fhis application and know the same to be true and correct. 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 the provisions of any other state or loca/ law regulating construction or the performance of construction. That I am authorized by the owner of fhis property to perform the work for which application is made and 1 comply with the State Contractors Law 18.27 RCW and 296.200 WAC. Agent Sign Date City of Evereft Official Use Only FEE f_ �.� f;, ��' `� nF; -�i PERMIT # � —a _ �� E� ,� � ! (Revised 10/12/2015)