1111 41ST ST 2017-06-07 - 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: •I I I L I'a BUILDING AREA(if residential, new construction, remodel,or addition) SF BUILDING TYPE: SFR-DETACHED ❑ SFR-ATTACHED ❑ DUPLEX ❑ MULTI-FAMILY-#OF UNITS: ❑ COMMERCIAL USE OF BUILDING: ELECTRICAL APPLICATION INFORMATION CONTRACT PRICE OF WORK: $ 1 i. NUMBER OF DEVICES (if low voltage): FIRE ALARM? ❑YES ❑ NO ASSOCIATED BUILDING PERMIT#(if applicable): DESCRIPTION OF WORK: CONTACT INFORMATION OWNER NAME; i b�. 1 Cv.� '1S TENANT NAME(If Commercial): OWNER MAILING ADDRESS: STREET LKS!, �C CITY V Yp[, -{�� STATE Ot- ZIP 2-6 OWNER PHONE: A--- 2J L ' �� I OWNER EMAIL: 1 CONTRACTOR NAME: CONTRACTOR ADDRESS: STREET �Un/� ,(/1)CI �I Q� n CITY tN V•�--1 STATE (+` ZIP CONTRACTOR PHONE: p �j /�� CONTRAC,/T�OR EMAIL: I/� �, Ceyr CONTRACTOR LIC.#(REQUIRED): f V_A6 (7 V-ACITYOF EVERETT BUSINESS LIC.#(REQUIRED): J PRIMARY CONTACT: ❑ OWNER L CONTRACTOR ❑OTHER(Please Specify) CONTACT NAME: CONTACT PHONE: _5W . lv'_ G CONTACT EMAIL: L,! 0 I AGREEMENT:I hereby certify that I have read and examined this application and know the same to be true and correct. All provis s of laws and ordinance goveming 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# Owner/A"uthorized Agent Signature Date (Revised 9/23/2016) �j