Laserfiche WebLink
�ECTRICAL PEF�MIT 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/permits <br />PROJECT SITE INFORMATION <br />PROJECT ADDRESS: Z I I 3 � I D 1� V�- <br />BUILDING AREA (if residential, new constructio , remodel r addition) SF <br />BUILDING TYPE: ❑ SFR-DETACHED ❑ SFR-ATTACHED ❑ DUPLEX ❑ MULTI-FAMILY -# OF UNITS: ❑ COMMERCIAL <br />USE OF BUILDING: ���SjC{.�' �tiCC? <br />ELECTRICAL APPLICATION INFORMATION <br />CONTRACT PRICE OF WORK: $ <br />NUMBER OF DEVICES (if low voltage): <br />FIRE ALARM? ❑ YES ❑ NO <br />ASSOCIATED BUILDING PERMIT # (if applicabie): <br />DESCRIPTION OF WORK: �� t s �� �r�-t- `��U.51 }�Ii..�S s. ux+�� � i� Iti� r �. <br />j..�. � <br />locu � 1 c c�-{�-� bC��-�.-u�� . 11n--l-t�— c.ov�-c�-c�S< c�k� e�c��-�,rts fi.. �-s <br />CONTACT INFORMATION <br />OWNER NAME: M,1 �? (,��.(,�� � 1 GV�cia-z� B�cL L� TENANT NAME (If Commercial): S�+`✓��= <br />OWNER MAILING ADDRESS: srREET I 13 %i t c� <br />CITY ��/.Q�ti��� STATE LU � ZIP �.� ZOl <br />OWNER PHONE: �'z� � 4-ZZ ' 31�3 OWNER EMAIL: G�'�.�'-(� l-> � 4tC��- C� � V�-� �•� C� r-r� <br />CONTRACTOR NAME: ���,Yt�v�� CL,v�Sfi`ruC�l u�� P <br />CONTRACTOR ADDRESS: sTReET Z`� �� �U ✓(� �-� <br />CITY 'l��v ����� STATE ��` ZIP � b�� 4 <br />CONTRACTOR PHONE: CONTRACTOR EMAIL: <br />CONTRACTOR LIC. #(REQUIRED): CITY OF EVERETT BUSINESS LIC. #(REQUIRED): <br />_ _ __ _ _ _ _ _ _ _ _ _ _ __ _ _ <br />PRIMARY CONTACT: �OWNER ❑ CONTRACTOR ❑ OTHER (Please Specify) <br />CONTACT NAME: CONTACT PHONE: � Z5 � 1}Z Z' 3/�� <br />a"`i �i�l �II �. r���-��L. CONTACT EMAIL: �,/�/I. f7/��_G/<=. � Pl�<<�� L d rrt <br />AGREEMENT: T hereby certify that ! have read and examined this application and know the same fo be true and correct. All provisions of laws and ordinances governing Ehis <br />type of work will be completed whether specified herein or not. The granfing of a permit does not presume to give authorify to violate or cancel the provisions of any other state or <br />local law regulating construction or the performance of construction. Thaf I am authorized by the owner of ihis property to perform the work for which applicafion is made and l <br />comply witir the State Contractors Law 18.27 RCW and 296.200 WAC. <br />Agent <br />/�3 :�i� <br />Date <br />City of Everett Official Use Only <br />FEE <br />��� ' '� i0 �,l ; <br />+� ����� <br />PERMIT# <br />E��Y��;� —�°o�-��� <br />(Revised 10/12/2015) <br />