Laserfiche WebLink
ELECTRICAL PERMIT APPLICATION <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: 3 r LJ % e-re* Lj� <br /> BUILDING AREA(if residential, new construction, remodel, or addition) 7!� SF <br /> BUILDING TYPE: ❑ SFR-DETACHED ❑ SFR-ATTACHED ❑ DUPLEX ❑ MULTI-FAMILY-#OF UNITS: 4a'50MMERCIAL <br /> USE OF BUILDING: <br /> ,EL°'ECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK: $ SO4'ao <br /> NUMBER OF DEVICES (if low voltage): <br /> FIRE ALARM? ❑YES ❑ NO <br /> ASSOCIATED BUILDING PERMIT# (if applicable): p <br /> DESCRIPTION OF WORK: tl�0P ?t2c7A 3.465ery1C>- With 1 4� ict- paftel acwuzf <br /> ne,Ness (-0A &J 3a0r kiwv AOD ori- 45'14VA X <br /> One A zo JeeLc vaiieL w,+E t Cc v <br /> 1-2 <br /> J <br /> CONTACT INFORMATION <br /> OWNER NAME: O r torr TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET <br /> CITY 7nOW�NER <br /> STATE ,y,�,�_OWNER PHONE: Z UOMAIL: S S C O [ 1 n O'^ Pn . C O W-) <br /> CONTRACTOR NAME: Servl ee5 <br /> CONTRACTOR ADDRESS: STREET 3 3 16 <br /> CITY �.,�r/ �TA;TE �� ZIP ,\ <br /> CONTRACTOR PHONE: GO 0.3 -(�S'� CONTRACTOR EMAIL: G�" 1Trl L 1GG'�1'C 6 J7. Z <br /> CONTRACTOR LIC.#(REQUIRED): AEs6RT- � D 3 7X •� CITY OF EVERETT BUSINESS LIC.#(REQUIRED):03 <br /> PRIMARY CONTACT: ❑ OWNER CONTRACTOR ❑ OTHER (Please Specify) <br /> CONTACT NAME: 3 <br /> I CONTACT PHONE: 40 yo3 •-0 <br /> 7/1-/'CuSSf�� 7-0/V CONTACT EMAIL: <br /> AGREEMENT:I hereby certify that l have read and examined this application and know the same to be true and correct. All provisions of laws and ordinances governing this type <br /> 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/am authorized by the owner of this property to perform the work for which application is made and I <br /> comply with the State Contractors Law 18.27 RCW and 296.200 WAC. <br /> City of Everett Official Use Only <br /> PERMIT# <br /> (Revised 9/23/2016) <br /> Owner/Authorized Agent Signature Date <br />