10 MADISON ST 2017-06-20 - Laserfiche WebLink

ELECTRICAL PERMIT APPLICATION CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET, EVERETT, WA 98201 (P)425-257-8810 1 FAX 425-257-8857 1 (E) everetteps@everettwa.gov I www.everettwa.gov/permits PROJECTSITE INFORMATION PROJECT ADDRESS: 10 M QI01 S l1FIIP/I o-v V h CW) r' BUILDING AREA(if residential,new construction, remodel,or addition) SF BUILDING TYPE: ❑ SFR-DETACHED FR-ATTACHED ❑ DUPLEX ❑ MULTI-FAMILY-#OF UNITS: ❑ COMMERCIAL USE OF BUILDING: ELECTRICAL APPLICATION INFORMATION CONTRACT PRICE OF WORK: $ NVJ D NUMBER OF DEVICES (if low voltage): FIRE ALARM? ❑YES NO ASSOCIATED BUILDING PERMIT# ifapplicable : DESCRIPTION OF WORK:: 2X V1� N vvtw toVIK-- CONTACT INFORMATION OWNER NAME: � TENANT NAME If Commercial): OWNER MAILING ADDRESS: STREET 0�7/�//J (F19/ 0^ CITY �v V V V STATE ZIP {v LO OWNER PHONE: 1OWNER EMAIL: 1 CONTRACTOR NAME: L(� / I ( f wp� I(I` CONTRACTOR ADDRESS: STREET�I�/If '� //!!rr (�,7Z � � CITY {�d`y�j�� STATE (�A ZIP I V CONTRACTOR PHONE:(4Z" ) 'U l�nCONTRACTOR EMAIL: V)y I CONTRACTOR LIC.#(REQUIRED):l N KbIA ES"l�'✓ C7 CITY OF EVERETT BUSINESS LIC.#(REQUIRED): D (02) PRIMARY CONTAC WNER ❑CONTRACTOR OTHER(Please Specify) CONTACT NAME: r / _ ( C CONTACT PHONE: �Qv CONTACT EMAIL: C� C •G�j'1� AGREEMENT.1 hereby certify that I have read and examined this application and know the same to be true andtlorrect. All provisio of laws Wd 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 a thorized 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 PERMIT# E o - DI Owner/Auth ized Agent Sig re to (Revised 9/23/2016)