6003 EVERGREEN WAY 2017-01-13 - Laserfiche WebLink

(P) 425-257-8810 �ECTRICAL PERMIT AP�ICATI ON CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET, EVERETT, WA 98201 FAX 425-257-8857 �(E) everetteps@everettwa.gov � www.everettwa.gov/permits PROJECT SITE INFORMATION PROJECT ADDRESS: ��6 7j �Cy-�,�� G�,�� ' ��-a�ti'✓d � ✓ '� BUILDING AREA (if residential, new construction, remodel, r addition) Y SF BUILDING TYPE: ❑ SFR-DETACHED ❑ SFR-ATTACHED ❑ DUPLEX ❑ MULTI-FAMILY -# OF UNITS: USE OF BUILDING: �� .}.ti� o- � � ��- COMMERCIAL ELECTRICAL APPLICATION INFORMATION CONTRACT PRICE OF WORK: $ r�0 d(�(� NUMBER OF DEVICES (if low voltage): � FIRE ALARM? ❑ YES NO ASSOCIATED BUILDING PERMIT # (if applicable): DESCRIPTION OF WORK: C9G,,}- ` CONTACT INFORMATION OWNER NAME: �� }- �� TENANT NAME (If Commercial): OWNER MAILING ADDRESS: srReer CITY STATE ZIP OWNER PHONE: OWNER EMAIL: CONTRACTOR NAME: CONTRACTOR ADDRESS: srREET 6 Zl r`G CITY STATE ZIP ��JLSO CONTRACTOR PHONE: Z—Z-3Q^ � S3d CONTRACTOR EMAIL: ��r q,� aa2 ie. � CONTRACTOR LIC. #(REQUIRED): `�1 S Z^ I� CITY OF EVERETT BUSINESS LIC. #(REQUIRED): PRIMARY CONTACT: ❑ OWNER �CONTRACT R ❑ OTHER (Please Specify) CONTACT NAME: CONTACT PHONE: �ZS" Z��.-� b�7� ,� � CONTACT EMAIL: AGREEMENT. T hereby cc�rtify that I ha e read and examined this application and know the same to be true and correct. All provisions of /aws 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 local law regulating construction or the pertormance of construction. That I 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. � OwnerlAuthorized Agen� Signature City of Everett Official Use Only FEE /'�]..j� � �� y ` �/ •_._ / �-/ 0 —� PERMIT # E i�5�2 � d (� (Revised 10/12/2015) >•s,�