2016 120TH PL SE 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: 0` 1'�O I SE UNIT tj BUILDING AREA(if residential, new construction, remodel, or addition) SF BUILDING TYPE: VSFR-DETACHED ❑ SFR-ATTACHED ❑ DUPLEX ❑ MULTI-FAMILY-#OF UNITS: ❑ COMMERCIAL USE OF BUILDING: ELECTRICAL APPLICATION INFORMATION CONTRACT PRICE OF WORK: $ 1200,00 NUMBER OF DEVICES if low voltage): FIRE ALARM? ❑YES (<NO ASSOCIATED BUILDING PERMIT#(if applicable): DESCRIPTION OF WORK: - z q CONTACT INFORMATION fi OWNER NAME: V1 'DQ ' ()U TENANT NAME If Commercial): OWNER MAILING ADDRESS: STREET 2Ol 1p Q SE CITY E\JQr 1+ STATE WA 71P [.O OWNER PHONE: OWNER EMAIL: CONTRACTOR NAME: L -Inc CONTRACTOR ADDRESS: STREET O &K -Ibs CITY Cov'\AkIhn STATE CONTRACTOR PHONE: JZ S3-[a3I-�I"ISO CONTRACTOR EMAIL: ��r�tkT YDvidtn}�leckviL.ru# CONTRACTOR LIC.#(REQUIRED): O VS Ln3GZ ICITY OF EVERETT BUSINESS LIC.#(REQUIRED): PRIMARY CONTACT: ❑OWNER L fCi-CONTRACTOR El OTHER(Please Specify) /_0 --t CONTACT NAME: 5havi A byx}nru CONTACT PHONE: ZS 3- I-T` Q eA 10016 CONTACTEMAIL: .erYjjAT 1'!VI&Yt .de"C.vta. AGREEMENT.1 hereby certify that/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/am authorized by the owner of this property to perform the work for which application is made and/ comply with the State Contractors Law 18.27 RCW and 296.200 WAC City of Everett Official Use Only PERMIT# J46 E C1 02- � b� �7wnertAuthorized Agent Signat4fe Yfate (Revised 9/23/2016)