6426 LOMBARD AVE 2017-06-20 - Laserfiche WebLink

ELECTRICALS PERMIT 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 www.everettwa.gov/permits PROJECT SITE INFORMATION PROJECT ADDRESS: 10ry. J6 BUILDING AREA(if residential, new construction,remodel,or addition) SF BUILDING TYPE: SFR-DETACHED ❑SFRATTACHED ❑ DUPLEX ❑MULTI-FAMILY-#OF UNITS: ❑COMMERCIAL USE OF BUILDING: Y"e S t e r"1 f t q ELECTRICAL APPLICATION INFORMATION CONTRACT PRICE OF WORK: $ 1 L4 NUMBER OF DEVICES(if low voltage): FIRE ALARM? YES ❑ NO ASSOCIATED BUILDING PERMIT#(if applicable): DESCRIPTION OF WORK: rC(V to t f CONTACT INFORMATION. . OWNER NAME: Ute TENANT NAME(If Commercial): OWNER MAILING ADDRESS: STREET Cv cYl a-y ve- CITY C V L r P 4 cC STATE ZIP OWNER PHONE: c: L (P O? — OWNER EMAIL: Cz 15003 Vr boV CL ,c CONTRACTOR NAME: CONTRACTOR ADDRESS: STREET eny STATE ZIP CONTRACTOR PHONE: CONTRACTOR EMAIL: CONTRACTOR LIC.#(REQUIRED): CITY OF EVERETT BUSINESS LIC.#(REQUIRED): PRIMARY CONTACT: NER ❑CONTRACTOR ❑OTHER(Please Specify) CONTACT NAME: CONTACT PHONE: CONTACT EMAIL: AGREEMENT.Thereby certify that/have read and examined this application and know the same to be true and correct. All provisions oflaws 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 I comply with the State Contractors Law 18.27 RCW aad 296.200 WAC. City of Everett Official Use Only FEE PERMIT# Owe u ¢ed Agent Signature ate (Revised 10/12/2015)