1205 50TH ST SW 2017-01-13 - Laserfiche WebLink

� �� ELECTRICAL PERMIT APPLICATION CITY OF EVERETT PERMIT SERVICES 3200 CED,4R STREET, EVERETT, WP� 9E201 (P) 425-257-8810 � FAX 425-257-8857 �(E) everetteps@everettwa.gov � www.everettwa.gov/permits PROJECT SITE INFORMATION PROJECT ADDRESS: (.��j a�'=` - �-.� BUILDING AREA (if residential, new construction, remodel, or addition) `� f:� SF BUILDING TYPE: ❑ SFR-DETACHED ❑ SFR-ATTACHED ❑ DUPLEX ❑ MULTI-FAMILY -# OF UNITS: ❑ COMMERCIAL USE OF BUILDING: �. J c- r �E�TRICAL APPLICATION INFORMATION CONTRACT PRICE OF WORK: $ � _ �;��— NUMBER OF DEVICES (if low voitage): FIRE ALARM? ❑ YES �-NO ASSOCIATED BUILDING PERMIT # (if applicable): DESCRIPTION OF WORK: �� w�,2�-i��t w � �' i ✓� CONTACT INFORMATION OWNER NAME: J ci`.�� ✓\ � �' �� TENANT NAME (If Commercial): OWNER MAILING ADDRESS: sTREET IZE; S �C_: Y�� j( ��:.�, CITY � �� 'e- � STATE �J � ZIP �� Ci � OWNER PHONE: OWNER EMAIL: CONTRACTOR NAME: �`( � � L C-TfZ ( L ��J\/� CONTRACTOR ADDRESS: srREEr Z l`-� 3( `� � �.J CITY �1' ( �.�/��C, STATE liLl � ZIP l,.J � CONTRACTOR PHONE: 'Z(JC� �G 5 Z ZZ CONTRACTOR EMAIL: c� I�_-t—v � L �'� t/'�:t, �� CONTRACTOR LIC. #(REQUIRED): 3� � LLE. � Z J� CITY OF EVERETT BUSINESS LIC. #(REQUIR ): �y �[ � � PRIMARY CONTACT: ❑ OWNER I�CONTRACTOR ❑ OTHER (Please Specify) CONTACT NAME: CONTACT PHONE: �;� ��,U � j Z Z �� t jLJ dU CONTACT EMAIL: AGREEMENT: 1 hereby certify that I have read and examined this application and know the same to be true and correct. All provisions of /aws and ordrnances goveming fhis 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 local law regulating construction or the performance of construction. That 1 am authorized by the owner of this property to pertorm the work for which application is made and I comply with the State Contractors Law 18.27 RCW and 296.200 WAC. � orized Agent Signature ��-��-�� Date City of Everett Official Use Only PERMIT # E �(�(b-�( ( ► (Revised 9/23/2016)