518 LEGION DR 2017-06-13 - Laserfiche WebLink

LECTRICAL PERMIT A :ILIGA ON CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET, EVERETT, WA 98201 (P) 425-257-8810 FAX 425-257-8857 1 (E) everetteps@everettwa.gov www.everettwa.gov/permits PROJECT SITE INFORMATION PROJECT ADDRESS: �! .i BUILDING AREA(if residential, new construction, remodel,or addition) SF BUILDING TYPE: ❑ / SFR-DETACHED IFR-ATTACHED ❑ DUPLEX ❑ MULTI-FAMILY-#OF UNITS: ❑ COMMERCIAL USE OF BUILDING: ,-S t �N ELECTRICAL APPLICATION INFORMAT16N CONTRACT PRICE OF WORK:$ Asc>o cj NUMBER OF DEVICES (if low voltage): FIRE ALARM? ❑YES ❑ NO ASSOCIATED BUILDING PERMIT#(if applicable): DESCRIPTION OF WORK: lets CONTACT INFORMATION OWNER NAME: OWNER MAILING ADDRESS: STREET .7� I It—tal'iC) i- CITY 1 � STATE ZIP OWNER PHONE: 7« 1OWNER EMAIL: CONTRACTOR NAME: QQ� CONTRACTOR ADDRESS: STREET (:n 1 CITY am 1 , STATE ZIP �y CONTRACTOR PHONE: CONTRACTOR EMAIL: CONTRACTOR LIC.#(REQUIRED): P(S ITY OF EVERETT BUSINESS LIC.#(REQUIRED 1 0-45 PRIMARY CONTACT:x ❑ OWNER VrWONTRACTOR y a❑OTHER(Please Specify) CONTACT NAME: CONTACT PHONE: 25- �►7 — k ' 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 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 M PERMIT 1t Owner/Authorized gent Signa a Date (Revised 10/1212015)