Laserfiche WebLink
WECTRICAL PERMIT AlfLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> (P) 425-257-8810 1 FAX 425-257-8857 1 (E) everetteps@everettwa.gov I www.everettwa.gov/permits <br /> PROJECT SITE INFORMATION <br /> PROJECT ADDRESS: ,Z. �!l ({ S I�(Q L <br /> BUILDING AREA(if residential, new construction, remodel,o addition) tr'p w,,j P SF <br /> BUILDING TYPE: ❑ SFR-DETACHED ❑ SFR-ATTACHED ❑ DUPLEX ❑ MULTI-FAMILY-#OF UNITS: JKCOMMERCIAL <br /> USE OF BUILDING: <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK: $ S <br /> NUMBER OF DEVICES (if low voltage): <br /> FIRE ALARM? ❑ YES gNO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIPTION OF WORK: t^ It Ll iC o 'C aa <br /> -9�I <br /> GJ i <br /> CONTACT INFORMATION <br /> OWNER NAME: V. TENANT NAME(If Commercial): Co j f- <br /> �v�STI <br /> OWNER MAILING ADDRESS: STREET T , i // <br /> CITY STATE ZIP <br /> OWNER PHONE: ZS .3L OWNER EMAIL: y; , cj <br /> CONTRACTOR NAME: <br /> CONTRACTOR ADDRESS: STREET <br /> CITY STATE ZIP <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: 1 `� na� �-S CONTACT PHONE: Z - 34-7gCi <br /> CONTACT EMAIL: �y <br /> AGREEMENT.'T hereby certify that I 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/am authorized by the owner of this property to perform the work for which application is made and/ <br /> comply with the State Contractors Law 18.27 RCW and 296.200 WAC. <br /> City of Everett Official Use Only <br /> FEE <br /> � Z�,�� <br /> PERMIT# <br /> �- E1 �0l <br /> (Revised 10/12/2015) <br /> OwnerlAuthorized nt Signature Date <br /> Age <br />