12319 14TH DR SE 2017-05-30 - 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: 61 67UG JAJ G+ BUILDING AREA(if residential, new construction, remodel, or addition)6wasA SF BUILDING TYPE: ❑ SFR-DETACHED P SFR-ATTACHED ❑ DUPLEX ❑ MULTI-FAMILY-#OF UNITS: ❑ COMMERCIAL USE OF BUILDING: ELECTRICAL APPLICATION INFORMATION CONTRACT PRICE OF WO411<G $3 NUMBER OF DEVICES (if low oltage): FIRE ALARM? ❑YES 9 N ASSOCIATED BUILDING PERM #(if applicable): DESCRIPTION OF WORK: Yom; CONTACT INFORMATION OWNER NAME: DA-A- aL4yeX TENANT NAME(If Commercial): OWNER MAILING ADDRESS: STREET 2_ CITY STATE k) ZIP Q OWNER PHONE: ,5 jj OWNER EMAIL: CONTRACTOR NAME: h jj CONTRACTOR ADDRESS: STREET CITY L STATE ZIP 813 CONTRACTOR PHONE: �Z6(a) 70 —91137 CONTRACTOR EMAIL: CONTRACTOR LIC.#(REQUIRED):EC LAS-*103-;5 W1CITY OF EVERETT BUSINESS LIC.#(REQUIRED) PRIMARY CONTACT: ❑OWNER [] CONTRACTOR OTHER(Please Specify) Proke .t CONTACT NAME: C' CONTACT PHONE: ;K & Q_ �- CONTACT EMAIL: (,206) Sol _ 41 AGREEMENT.I 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 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 I comply with the State Contractors Law 18.27 RCW and 296.200 WAC. City of Everett Official Use Only PERMIT# E Owner/ o zed Agent Signature Date (Revised 9/23/2016)