Laserfiche WebLink
-ECTRICAL PERMIT A 'LICATI®N <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> (P) 425-257-8810 FAX 425-257-8857 1 (E) everetteps@everettwa.gov I www.everettwa.gov/permits <br /> PROJECT SITE INFORMATION <br /> PROJECT ADDRESS: -7 <br /> BUILDING AREA(if residential, new construction, remodel, or addition) /V 4 SF <br /> BUILDING TYPE: ❑ SFR-DETACHED ❑SFR-ATTACHED ❑ DUPLEX ❑ MULTI-FAMILY-#OF UNITS: COMMERCIAL <br /> USE OF BUILDING: <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK: $ <br /> NUMBER OF DEVICES (if low voltage): <br /> FIRE ALARM? ❑ YES ONO <br /> ASSOCIATED BUILDING PERMIT# (if applicable): N <br /> DESCRIPTION OF WORK: yt s P Z >f C 'rc w lj ,- x►�) �' <br /> � CONTACT INFORMATION <br /> C <br /> OWNER NAME: k-. i //e- TENANT NN/AME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET J� Ci / r-d0-, �1 ��(1, ,3 <br /> CITY et74 STATE 1-4: /zip <br /> OWNER PHONE: Z S�- - (� ,?7 OWNER EMAIL: r]'j` S[1y /01-CL- L045r✓ri- <br /> CONTRACTOR NAME: / <br /> CONTRACTOR ADDRESS: STREET J()I�l I <br /> CITY �vcA 4 STATE zip 74 <br /> CONTRACTOR PHONE: Z - CONTRACTOR EMAIL: Lhh <br /> CONTRACTOR LIC.#(REQUIRED):Vl-!,L Fr- ' / /Vj" CITY OF EVERETT BUSINESS LIC.#(REQUIRED): O U, S <br /> PRIMARY CONTACT: ❑ OWNER ACONTRACTOR ❑ OTHER(Please Specify) <br /> CONTACT E: CONTACT PHONE: 2 7 _ <br /> �4 �% rj CONTACT EMAIL: C , VC e <br /> ly <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 I 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 /> I�-] 4)�()- <br /> PERMIT# <br /> O ner/Au orized Agent Signature Date (Revised 10/12/2015) <br />