4716 EVERGREEN WAY B 2017-05-03 - Laserfiche WebLink

ELECTRICAL PERMIT APPLICATION CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET, EVERETT, WA 98201 (P) 425-257-8810 1 FAX 425-257-8857 1 (E) everetteps@everettwa.gov I www.everettwa.gov/permits � ## —}T" PROJECT SITE INFORMATION t �` PROJECT ADDRESS: " ' '`(C '-� LA—q j. BUILDING AREA(if residential,new construction, remodel,or addition) SF BUILDING TYPE: 11 SFR-DETACHED 13 SFR-ATTACHED ❑ DUPLEX ❑ MULTI-FAMILY-#OF UNITS; COMMERCIAL USE OF BUILDING: ELECTRICAL APPLICATION INFORMATION CONTRACT PRICE OF WORK: $ NUMBER OF DEVICES if low voltage): FIRE ALARM? ❑YES ❑ NO ASSOCIATED BUILDING PERMIT# if applicable): DESCRIPTION OF WORK: CONTACT INFORMATION OWNER NAME: } ✓ TENANT NAME If Commercial): ! OWNER MAILING ADDRESS: STREET }, i—LO- CITY STATE 11\,ii S ZIP Y)Q59 OWNER PHONE: L' '�? ' l c050 OWNER EMAIL: CONTRACTOR NAME: - w CONTRACTOR ADDRESS: STREET CRY STATE ZIP CONTRACTOR PHONE: t 0 CONTRACTOR EMAIL: CONTRACTOR LIC.#(REQUIRED; '� CITY OF EVERETT BUSINESS LIC,#(REQUIRED): PRIMARY CONTACT: ❑OWNER ACONTRACTOR ❑OTHER(Please Specify). CONTACT NAME: , CONTACT PHONE: t CONTACT EMAIL: ,( 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 04, aaces 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 performance of construction. That I am authorized by the owner of this property to perform the work for which application is made and/ comply with the State Contractors Law 18.27 RCW and 286.200 WAC. City of Everett Official Use Only FEE PERMIT# ! . E _ 12 � Owner/Authorized Agent Signature dafe (Revised 10/12/2015)