1905 16TH ST 2016-11-08 - Laserfiche WebLink

�,ECiRICAL 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 PROJECT ADDRESS: �,� (% E+ � C Z� � 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: ELECTRICAL APPLICATION INFORMATION CONTRACT PRICE OF WORK: $ - vUU NUMBER OF DEVICES (if low voltage): fl FIRE ALARM? ❑ YES NO ASSOCIATED BUILDING PERMIT # (if applicable): DESCRIPTION OF WORK: - � ;� �'� - CONTACT INFORMATION OWNER NAME: '7 2y` � TENANT NAME (If Commercial): OWNER MAILWG ADDRESS: s�eEr � — -- CITY G.�j2—� STATE % ZIP ^ �ZC%J OWNER PHONE: c.{ � �'y �(/�/ OWNER EMAIL: � yL�Z c<% < Yl(�►!,_ CONTRACTOR NAME: � - �z CONTRACTOR ADDRESS: sTReeT �%Z � — ��N L SI E�I�1S STATE ZIP ��` ' �� CONTRACTOR PHONE: 'l,5 2�-(�i SS// CONTRACTOR EMAIL: ,jC(Zl,'� c:.�.'}7�f ' li%C - r�(C�. (� CONTRACTOR LIC. #(REQUIRED): �,, ,T � <((.�'� CITY OF EVERETT BUSINESS LIC. #(RE4UIRED): _ _ _ PRIMARY CONTACT: ❑ OWNER ❑ CONTRACTOR ❑ OTHER (Please Specify) CONTACT NAME: CONTACT PHONE: CONTACT EMAIL: AGREEMENT: T hereby certify that 1 have read and examined this 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 fo violate or cancel the provisions of any other state or local law regulating construction or the pe�formance of construction. That I am aufhorized by the owner of this property to perform the work for which application is made and 1 comply wilh the State Contractors Law 18.27 RCW and 296.200 WAC. Owner/Authorized Agent Signature Date City of Everett Official Use Only FEE � �� - � _ PERMIT # E �� (Revised 10/12/2015)