1210 MADRONA AVE 2017-06-20 - Laserfiche WebLink

ELECTRICAL PERMIT APPLICATION CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET, EVERETT, AWA 98201 (P) 425-257-8810 1 FAX 425-257-8857 1 (E)everetteps@everettwa.gov I www.everettwa.gov/permits P055ftT SITE INFORMATION PROJECT ADDRESS: t+ e,elro(w 2-0--i BUILDING AREA(if residential, new construction,remodel,or addition) SF BUILDING TYPE: 0 SFR-DETACHED SFR-ATTACHED O DUPLEX ❑MULTI-FAMILY-#OF UNITS: ©COMMERCIAL USE OF BUILDING: ELECTRICAL APPLICATION INFORMATION CONTRACT PRICE OF WORK: $ 46o o NUMBER OF DEVICES (if low voltage): FIRE ALARM? ❑YES O NO ASSOCIATED BUILDING PERMIT#(if applicable): DESCRIPTION OF WORK: 0 + A-- f t (x, CONTACT INFORMATION OWNER NAME: (,tit"'1L TENANT NAME(If Commercial): OWNER MAILING ADDRESS: SIR-T G CITY vTA'i� W P, OWNER PHONE: OWNER EMAIL: V CONTRACTOR NAME: CONTRACTOR ADDRESS: STET -- I-- CITY �4 (. }� STATE ZIP CONTRACTOR PHONE:C.3(00)� d CONTRACTOR EMAIL: 0 1 C r` CONTRACTOR LIC_#(REQUIRED): ]A V Lc?s4 hli+- CITY OF EVERETT BUSINESS LIC.#(REQUIRED): 05 'Z(0% l PRIMARY CONTACT: 0 OWNER ,CONTRACTOR ❑OTHER(Please Specify) t _ CONTACT NAME: CONTACT PHONE: +S t i tJGV— qzyk Sf-^ CONTACT EMAIL: AGREEMENT:Thereby certify that l have read and examined this application and know the same to be true and correct_ All provisions of laws and ordinances governing this "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 lase regulating construction or the performance of construction. That tam authorized by the owner of this property to perform the work for which application is made and 1 comply with the State Contractors Law 18 27 RC'W and 296.200 WAC. City of Everett Official Use Only FEE { 0 PERMIT# ' 7' E �CoCS Q41erlAithorized Agent Signature Date (Revised 10112,2015)