Laserfiche WebLink
� <br />� <br />�LECTRICAL PERMIT A�LICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />(P) 425-257-8810 � FAX 425-257-8857 �(E) everetteps@everettwa.gov � www.everettwa.gov/p��rmits <br />PROJECT SITE INFORMATION <br />PROJECT ADDRESS: I �: "L' �� �� I.�UL� V L:-��--t 11�"11 �1 I I ` '�' .l L �� L�l i �f'' �� �-1,���'C'--f. _ / � � �'_ ��� <br />BUILDING AREA (if residential, new construction, remodel, or addition) � SF <br />BUILDING TYPE: ❑ SFR-DETACHED ❑ SFR-ATTACHED ❑ DUPLEX ❑ MULTI-FAMILY -# OF UNITS: CC)MMERCIAL <br />� <br />USE OF BUILDING: I%��t' `;} ( I i.{ YC{,,y�� <br />ELECTRICAL APPLICATION INFORMATION <br />CONTRACT PRICE OF WORK: $ �'� (;J C, ��� <br />� <br />NUMBER OF DEVICES (if low volta e): �' <br />FIRE ALARM? YES ❑ NO <br />ASSOCIATED BUILDING PERMIT # (if applicable): <br />DESCRIPTION OF WORK: ����1'}-1 �� % , � I���'✓� `'� `Y )'n - � 1'1C�I %d ; �' � Ill >l�f'� `� �YU%'.� <br />� )'✓ "�/�1 - _� i>C.��%�` 1 G��'1 <br />CONTACT INFORMATION <br />OWNER NAME , �j'r' 1��`� j' ! ��},�i i �`_t"� i � v� ��' � . �� TENANT NAME Qf Commercial): � ��, Y `� E' V' • i ��� �.� � �vM� � <br />OWNER MAILING ADDRESS: sTReer I(,)�� JL �� �j� � <br />CITY �`�� 1� � I`�' � I STATE b'�l/ �-1 ZIP � f ZJU i I <br />OWNER PHONE: �����' �-�� �� l 7 OWNER EMAIL: <br />CONTRACTOR NAME: ��,�� � � �/'� <br />CONTRACTOR ADDRESS: sTReer � % ? � ' <br />CITY (^�/�' (7 STATE �/ �/ r f ZIP"1 �/(/�'i"� <br />CONTRACTOR PHONE: � I,' � �� X �U� CONTRACTOR EMAIL• L(',�I y'� }���f' I� C=�I ��r�G . I � �I )l. -y�� � � , � <br />CONTRACTOR LIC. #(REQUIRED): '�y�`�("�j�� � �,j CITY OF EVERETT BUSINESS LIC. #(REQUIRED): �� I�nl ��% <br />PRIMARY CONTACT: ❑ OWNER �CONTRACTOR ❑ OTHER (Please Specify) <br />CONTACT NAME: CONTACT PHONE: � Lj�j -"7Gj7� Gj �j (�� �C 1 l)3 <br />L��� �-�� I����� J�}�C � CONTACT EMAIL: �'?�.C�1')J� � C� t�-�SGQ�� �1 I LL l�� • G�� <br />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 <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 I am authorized by the owner of this property to pertorm the work for which application is made and I <br />comply with the State Contractors Law 18.27 RCW and 296.200 WAC. <br />�;����%��l (.�%,'V,�'�(.t-;% � <br />uthorized Agent ignature <br />City of Everett Official Use On/y <br />FEE <br />���s��� <br />� <br />PERMIT # <br />E � �� <br />(Revised 10/12/2015) <br />