1108 CHESTNUT CT 2017-06-09 - Laserfiche WebLink

ELECTRICALS PERMIT fi�PPLQCATION CITY OF EVERETT PERMIT— -VICES 3200 CEDAR STREET, EVERETT,WA 98201 (P)425-257-8890 FAX 425-257-8857 1 (E) everetteps@everettwa.gov www.everettwa.gov/permits ROLA CT SATE INFO>I3i lAtT90. PROJECT ADDRESS: CST-IIIU� BUILDING AREA(if residential, new construction,remodel, or addition) )!SC o SF BUILDING TYPE: ❑SFR-DETACHED IFR-ATTACHED ❑ DUPLEX ❑ MULTI-FAMILY-#OF UNITS: CI COMMERCIAL USE OF BUILDING: ELECTRICAL APPLICATION INFORMATION CONTRACT PRICE OF WORK:$ 5'sdo NUMBER OF DEVICES (if low voltage): FIRE ALARM? ❑YES ITNO ASSOCIATED BUILDING PERMIT#(if applicable): DESCRIPTION OF WORK: lj �r LSU ,(gyp 00ET- w r CONTACT IIa1FORMATION OWNER NAME: N)C,4� TENANT NAME(If Commercial): OWNER MAILING ADDRESS: STREET CITY STATE ZIP OWNER PHONE: OWNER EMAIL: CONTRACTOR NAME: CONTRACTOR ADDRESS: STREET f W CITY W66 STATE Ld P� ZIP a.%21 CONTRACTOR PHONE: �, 367 5 5� COQ NNTRACTOR EMAIL: (�t \ 1� { (1 1 CONTRACTOR LIC,#(REQUIRED): SU M M IC- Qd K CITY OF EVERETT BUSINESS LIC.#(REQUIRED): Qrj PRIMARY CONTACT: ❑ OWNER ACONTRACTOR ❑OTHER(Please Specify) CONTACT NAME: CONTACT PHONE: L-!__ CONTACT EMAIL: AGREEMENT.'Thereby certify that I 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 ornot. The granting of a permit does not presume to give authorify 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/ comply with the State Contractors Law 18.27 RCW and 296.200 WAC. City of Everett Official Use Only FEE V �% PERMIT# OvvnerlAuttiorized Agent Signature Date (Revised 10/12/2015)