4922 COLBY AVE 2017-06-12 - Laserfiche WebLink

ELECTRICAL PERM IT APPLICATION CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET, EVERETT, WA 98201 (P)425-257-8810 FAX 425-257-8857 1 (E) everetteps@everettwa.gov I www.everettwa.gov/permits PROJECT SITE INFORMATIOf I PROJECTADDRESS: 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: LE TRICA APPLICATION INFORMATION CONTRACT PRICE OF W K:$ NUMBER OF DEVICES(if 16 voltage): FIRE ALARM? ®YES ASSOCIATED BUILDING PERMIT#(if applicable): DESCRIPTION OF WORK: L v J 0;f4e, CONTACT INFORMATION OWNER NAME: �Ao w y A % J TENANT NAME(If Commercial): OWNER MAILING ADDRESS: STREET ? Ci C'L `/ \I Z ,I �1 CITY �� STATE �^ /� ZIP 9 OWNER PHONE: `10� �SoJ• 3Cs73 3 OWNER EMAIL: CONTRACTOR NAME: CONTRACTOR ADDRESS: STREET CITY STATE ZIP CONTRACTOR PHONE: CONTRACTOR EMAIL: CONTRACTOR LIC.#(REQUIRED): CITY OF EVERETT BUSINESS LIC.#(REQUIRED): PRIMARY CONTACT: 1�t OWNER ❑CONTRACTOR ❑OTHER(Please Specify) CONTACT NAME: CONTACT PHONE: qa ;,7 --M C� I v_: 7J 1 CONTACT EMAIL: AGREEMENT.T hereby 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 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 FEE PERMIT# Owner/Aut or!zed Agent Signature 6ate I (Revised 10/12/2015)