Laserfiche WebLink
�a=��TRICAL ��RI�I� �`��'�LIC�`�IOIV <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> (P) 425-257-8810 � FAX 425-257-8857 � (E) everetteps@everettwa.gov � www.everettwa.gov/permits <br /> PRO.J@G7' SITE IPIFORM�►TIO�1 <br /> PROJECT ADDRESS: ��( Of� G�. � (� <br /> BUILDING AREA(if residential, new construction, remodel, or addition) ?7f,%U SF <br /> BUILDING TYPE: ❑ SFR-DETACHED SFR-A�ACHED ❑ DUPLEX ❑ MULTI-FAMILY-#OF UNITS: ❑ COMMERCIAL <br /> USE OF BUILDING: <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK: $ S�v <br /> NUMBER OF DEVICES (if low voltage): <br /> FIRE ALARM? ❑ YES NO <br /> ASSOCIATED BUILDING PERMIT# (if applicable): <br /> DESCRIPTION OF WORK: �,��f` ,� Z2-t;� � ►�C.��'+� �-- c,� ,� <br /> � � S�\�C C� c� �:.>Y-.�_ � �� <br /> CONTACT INFORMATION <br /> OWNER NAME: TENANT NAME(ff Commercial): <br /> OWNER MAILING ADDRESS: sTReer <br /> CITY STATE ZIP <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: � �l2-� �—�� C�Z � � <br /> CONTRACTOR ADDRESS: srReer ��� �. � <br /> CITY �J � Q� STATE C�� ZIP O �-�/� <br /> CONTRACTOR PHONE: 2 � �j3� 00��-- CONTRACTOR EMAIL: � ��� , C� C E' (Y� 1 � � <br /> CONTRACTOR LIC.#(REQUIRED): Cjt�G�.� �-�.-�� �� � CITY OF EVERETT BUSINESS LIC.#(REQUIRED): <br /> ___...:. . _..__. .:...- ,..._,.. ...:.... ..... ....... .. . .... , _..... _ .,. : ...._. __ ..._... ....... ...._ .. <br /> ...,..... <br /> PRIMARY CONTACT: ❑ OWNER �CONTRACTOR ❑ OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: Z� �3 '�j J CE oc}Z <br /> �(�k �� , �� CONTACT EMAIL: f /��. L � e �� <br /> AGREEMENT:T hereby certify fhat have read and examined this application and know the same fo be frue and correct AI!provisions of laws an rdinances govemrng this <br /> type of work will 6e completed whether specified herern or not. The granfing of a permrE does not presume to give aufhorify fo violate or cancel the provisions of any other sfate or <br /> 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 <br /> comply with the State Contractors Law 18.27 RCW and 296,200 WAC. <br /> City of Everett Officia!Use Only <br /> FEE <br /> o�OC� � <br /> �' _ PERMIT# <br /> � � �5 E � �D (- � �� <br /> Owner/Authorized Agent Siynature Date (Revised 90/12/2015) <br /> 1 <br />