Laserfiche WebLink
Ei.'tCTRICAL PERMIT APP�ICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 9$2d1 <br /> (P)425-257-8810 � FAX 425-257-8857 � (E)everetteps@everettwa.gov� www.everettwa.gov/permits <br /> PROJECT SITE INFORMATION <br /> . .--� . � t C"-� C � <br /> PROJECT ADDRESS: , � ��—=,---r : r e `�•f f� _. � ) L. J ..� k l l.';;�" �'t"�f��,,�' � L _ <br /> BUILDING AREA(if residential,new construction, remodel,or addition) SF <br /> BUILDING TYPE: ❑SFR-DETACHED ❑SFR-ATTACHED ❑DUPLEX ❑MULTI-FAMILY-#OF UNITS: �COMMERCIAL <br /> USE OF BUILDING: <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK:$ ` ," �"1� �� <br /> NUMBER OF DEVtCES (if low volta e : <br /> FIRE ALARM? ❑YES ❑NO <br /> ASSOCIATED BUILDING PERMIT# if a licabie : <br /> DESCRIPTION OF WORK: xF �.�, � � � � 4. C.�I . �. . ,; �;,` , � , °;' � .�>t <br /> � ;:,� � } E <br /> � �f � r -��__� „� i4 L i w� e � ' <br /> CONTACT INFORMATION <br /> OWNER NAME: �,k i;�r�°- e. �'.' F 'r � �k.� I F TENANT NAME(If Commercial): <br /> � ,� <br /> OWNER MAILING ADDRESS: srneeT '"� I � p I I � .� � a „,.,. , t t^ �I ."1 �, . , <br /> � �cirr v� 0, �� ` �,t srnre ' :,� :, ziP `� � � <br /> OWNER PHONE r.°� �,;, r<'� ����.,�e`� ''� J� t'�� OWNER EMAIL: <br /> � ��. <br /> CONTRACTOR NAME: "y''�,r' ' '" • � ^t . �� M q� F <br /> CONTRACTOR ADDRESS: s�aeEr Q` '" �n�,r:�w. ' ` <br /> � � <br /> CITY �, A C.i��;F 1�' .. STATE "•�M� ZIP r� .:�V �� - <br /> CONTRACTOR PHONE: A;,�ap� � "4.'i7 ' ',� ' CONTRACTOR EMAIL:� r'\ . 4' I `*' I�r � } i . �.� ��,r � r � ' <br /> CONTRACTOR LIC.#(REQUIRED):�-. � r� � ' •-i CITY OF EVERETT BUSINESS LIC.#(RE(2UIRED): <br /> PRIMARY CONTACT: ❑OWNER �'CONTRACTOR ❑OTHER(Please Specify) � <br /> CONTACT NAME: CONTACT PHONE: ri !�„:'� : ; �„ �,,, � '; <br /> �:<• � � � �:. <br /> .., �.� t;.s �;a f _ �� ' y� : CONTACT EMAIL�• ''R ti r � <br /> , � <br /> +" �'� i �- �i .,.� t, f.� �` � �_`�?i� <br /> AGREEMENT:1 hereby cerfify that I have read and examined this application and know the same to 6e true and correct. All p ovisions of laws and ordinances goveming this rype <br /> 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 <br /> local Iaw regulating constuction or the perfomiance of construction. That I am authorized by the owner of this property to perform the work for which appiica6on is made and I <br /> comply with the State Contractors Law 18.27 RCW and 296.200 WAC. <br /> City of Everett Official Use Onty <br /> ! , PERMIT# <br /> � R i <br /> �� ~�� ���% E 1��� - ��-0 <br /> OwnedA rized Agent Si natu Date (Revised 9/13/2016) <br /> � <br />