607 47TH ST SE 2017-06-07 - Laserfiche WebLink

EOCTRICAL PERMIT APP ;ATION 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: �St- v4 n'l BUILDING AREA(if residential, new construction, remodel, or addition) SF BUILDING TYPE: ElSFR-DETACHED ❑ SFR-ATTACHED E] DUPLEX MULTI-FAMILY-#OF UNITS] COMMERCIAL USE OF BUILDING: ELECTRICAL APPLICATION INFORMATION CONTRACT PRICE OF WORK: $ �tS� NUMBER OF DEVICES (if low voltage): FIRE ALARM? ❑YES NO ASSOCIATED BUILDING PERMIT# (if applicable): DESCRIPTION OF WORK: CONTACT INFORMATION OWNER NAME: 11` L.-1,✓e+lM-F -'T IANT NAME(If Commercial): OWNER MAILING ADDRESS: STREET 10" ,W C11TY STATE /""�' ZIP OWNER PHONE: 1 1-11—^l OWNER EMAIL: LV4'0(c) �. _ • Q0 CONTRACTOR NAME:Rto CONTRACTOR ADDRESS: STREET I� I /LP L ?j CITY STATE ZIP { � CONTRACTOR PHONE: r1 Q) CONTRACTOR EMAIL: `r' "Al CONTRACTOR LIC.#(REQUIRED)211—� F CQ��13 CITY OF EVERETT BUSINESS LIC.#(REQUIRED)D S;'1 PRIMARY CONTACT: ❑ OWNER ONTRACTOR ❑ OTHER (Please Specify) CONTACT NAME: CONTACT PHONE: (/ QL4' ►/1 CONTACT EMAIL: AGREEMENT Thereby certify that I have read no 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 spe '' 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 FEE bb ,r7b PERMIT# E x-'103 - 1 ( 4 Owner/Authorized nt Signature Date (Revised 10/12/2015)