4909 CHINOOK DR 2017-05-23 - 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 PROJECT SITE INFORMATION PROJECT ADDRESS: BUILDING AREA(if residential, new construction, remodel,or addition) SF BUILDING TYPE: 6,SFR-DETACHED ❑ SFR-ATTACHED ❑ DUPLEX ❑ MULTI-FAMILY-#OF UNITS: ❑COMMERCIAL USE OF BUILDING: j ELECTRICAL APPLICATION INFORMATION CONTRACT PRICE OF WORK: $ NUMBER OF DEVICES if low voltage): FIRE ALARM? ❑YES ONO ASSOCIATED BUILDING PERMIT#(if applicable): DESCRIPTION OF WORK: CONTACT INFORMATION OWNER NAME: TENANT NAME(If Commercial): OWNER MAILING ADDRESS: STREET v� �n p1�� ,L CITY U e. STATE ZIP OWNER PHONE: : :30;� 3'a2 OWNER EMAIL: CONTRACTOR NAME: no e CONTRACTOR ADDRESS: STREET QCD o I�(p j1 SJ� o s /- CITY nAzidlod STATE ZIP CONTRACTOR PHONE: S1 6() CONTRACTOR EMAIL: �/� , (�SYyt CONTRACTOR LIC.#(REQUIRED):C' t/LW I��}} ��'lYt CITY OF EVE ETT BUSINESS LIC.#(REQUIRED): PRIMARY CONTACT: ❑OWNER CONTRACTOR ❑OTHER(Please Specify) CONTACT NAME:: �, CONTACT PHONE: tJ Qv ate/� e 16c y � ��`'` CONTACT EMAIL: AGREEMENT:I hereb certify that 1 have read and examined this application and know the same to be true I correct. All provisions of laws and ordinances verning 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 1 am authorized by the owner of this property to perform the work for which application is made and I comply with the State Contractors Law 18.27 RCW and 296.200 WAC. City of Everett Official Use Only PERMIT# yao E��ID(I" IT/ Owner/Authors Agent Signature Date ' (Revised 9/23/2016)