7515 BROADWAY 2017-06-09 - Laserfiche WebLink

ELECTRICAL PERMIT APPLICATION CITY OF EVERETT PERMIT VICES 3200 CEDAR STREET, EVERETT, WA 98201 (P)425-257-8810 FAX 425-257-8857 1 (E) everetteps@everettwa.govwww.everettwa.gov/permits ORO,ACT SATE INFO N PROJECT ADDRESS: BUILDING AREA(if residential, new construction,remodel,or ad Ition) .2/O h SF BUILDING TYPE: El SFR-DETACHED ) I SFR ATTACHED ❑ DUPLEX ❑ MULTI-FAMILY-#OF UNITS: ❑ COMMERCIAL USE OF BUILDING: ELECTRICAL APIOLICATIOM INFORMATION CONTRACT PRICE OF WORK:$ 90006 D NUMBER OF DEVICES(if low voltage): FIRE ALARM? ❑YES ❑NO ASSOCIATED BUILDING PERMIT# (if applicable): DESCRIPTION OF WORK: i,/, ,' r. p e 7 CONTACT.•INFORMATION OWNER NAME: ��,, 1,: ,jln T cr TENANT NAME(If Commercial): OWNER MAILING ADDRESS: STREET crrY STATE ZIP OWNER PHONE: .201, ,9� OWNER EMAIL: CONTRACTOR NAME: 0 CONTRACTOR ADDRESS: sTREEr 1132 O f y� Al-e- jt CIN Ar /h 1J h STATE ��,� ZIP CONTRACTOR PHONE: y,2 �p !?,390L' CONTRACTOR EMAIL: CONTRACTOR LIC.#(REQUIRED): /t/0/Z ZV"oy *7A CITY OF EVERETT BUSINESS LIC.#(REQUIRED):,03.2If 0 PRIMARY CONTACT: ® OWNER ❑CONTRACTOR ❑OTHER(Please Specify) CONTACT NAME: CONTACT PHONE: z CONTACT EMAIL: AGREEMENT.'Thereby certify that t 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 1 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 PERMIT# OwnedAutfiorized Agent Signatte Date (Revised 10/12/2015)