2621 GRAND AVE 2017-05-24 - Laserfiche WebLink

PECTRICAL PERMIT APPLICATION CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET, EVERETT, WA 98201 (P)425-257-8810 FAX 425-257-8857 (E)everefteps@everettwa.gov www.everettwa.gov/permits NF3IIIIII)IA'Il II . . ......... PROJECT ADDRESS: BUILDING AREA(if residential, new construction,remodel,or addition) SF IBUILDING TYPE: OiFIR-DETACHED 13 SFR-ATTACHED 0 DUPLEX 11 MULTI-FAMILY-#OF UNITS: 13COMMERCIAL IUSE OF BUILDING: ELECTRICAL APPLICATION INFORMATION CONTRACT PRICE OF WORK: $ NUMBER OF DEVICES if low voltage): FIRE ALARM? 13 YES 0 NO ASSOCIATED BUILDING PERMIT# if aephcable): DESCRIPTION OF WORK: Sr T''TT "77! CNFACT 1NP6@7A7'i6N '4q OWNER NAME: PL e(i TENANT NAME if Commercial): OWNER MAILING ADDRESS: STREET CITY ey e-r e,++ STATE h ZIP OWNER PHONE: 2Q ..JOWNER EMAIL: CONTRACTOR NAME: [&:Ay* CONTRACTOR ADDRESS: STREET -?C> crty STATE w-A ZIP CONTRACTOR PHONE: 1CONTRACTOR EMAIL: CONTRACTOR LIC.#(REQUIRED): t ICITY OF EVERETT BUSINESS LIC.#(REQUIRED)- 5 PRIMARY CONTACT: 0 OWNER EI-60NTRACTOR 0 OTHER(Please Specify) CONTACT NAME: 1CONTACT PHONE: CONTACT EMAIL: AGREEMENT.T hereby cartffy that I have read and examined this application and know the same to be true and corract. All provisions of laws 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 performance of construdion. That I 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 FEE 44 E� PERMIT# OwriariAuthorized;A'gent Signature Date (Revised 1011212015)