5200 EVERGREEN WAY 2017-05-23 - Laserfiche WebLink

ELECTRICAL PERMIT APPLICATION CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET, EVERETT, WA 98201 (P)425-257-8810 I FAX 425-257-8857 I (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: O SFR-DETACHED O SFR-ATTACHED O DUPLEX O MULTI-FAMILY-#OF UNITS: COMMERCIAL USE OF BUILDING: Wc ELECTRICAL APPLICATION INFORMATION CONTRACT PRICE OF WORK:$ CO NUMBER OF DEVICES if low voltage): 2- FIRE FIRE ALARM? o YES 0 NO ASSOCIATED BUILDING PERMIT# if applicable): 5 (O Z.—00 DESCRIPTION OF WORK: 1� II k CONTACT INFORMATION OWNER NAME: S { TENANT NAME(If Commercial): 1 L N{.Q{—CN$ OWNER MAILING ADDRESS: STREET ''\\ CITY STATE U zip l-1 V OWNER PHONE: I OWNER EMAIL: CONTRACTOR NAME: M !°d {� V CONTRACTOR ADDRESS: STREET a CTyof jU �(\ STATE ( } ZIP`Z Is 7 CONTRACTOR PHONE: Z — CONTRACTOR EMAIL: ,S /� ((fit CONTRACTOR LIC.#(REQUIRED): CITY OF EVERETT BUSINESS LIC.#(REQUIRED):Z PRIMARY CONTACT: O OWNER q-CONTRACTOR 0 OTHER(Please Specify) CONTACT NAME: CONTACT PHONE: 111 \ CONTACT EMAIL: ` AGREEMENT:I hereby certify that t have read and examined this application and know the same to be true and correct. All provisio s of latus and ordinances governing this type of work will be completed whether speed 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 1 comply with the Stale Contractors Law 18.27 RCW and 286.200 WAC. City of Everett Official Use Only PERMIT# l 3 E Owner! uthorized Agenvignature Date (Revised 923/2016) I I