4408 FOREST DR 2017-09-01 - Laserfiche WebLink

ELECTRICAL PERMIT PLICATION CITY OF EVERETT PERMI RVICES 3200 CEDAR STREET, EVERETT,WA 98201 (P)425-257-8810 FAX 425-257-8857 (E) everetteps@everettwa.gov www.everettwa.gov/permits lia) �i CT• PROJECT ADDRESS: p {(G S f, BUILDING AREA(if residential,new construction, remodel, or addition) 30 SF BUILDING TYPE: ❑SFR-DETACHED ❑SFR ATTACHED I] DUPLEX ❑MULTI-FAMILY-#OF UNITS: II COMMERCIAL [US--EOF BUILDING: lj . CAL P�i.11e:�T9®R9 il��®�t@l11ATIO FONTRACTRICE OF WORK $ . t)DEVICES(if low voltage): FIRE ALARM? ❑YES D{NO ASSOCIATED BUILDING PERMIT#(if Z 7 applicable): DESCRIPTION OF WORK: x(n) 6 q 4 Ost ZQD CONTACTt INFORMATION OWNER NAME: �~� TENANT NAME(If Commercial): OWNER MAILING ADDRESS: STREET y 'e� ��.� FAD -� /� CITY STATE C�� ZIP OWNER PHONE: Ajl,S L U D OWNER EMAIL: CONTRACTOR NAME: U t+y e CONTRACTOR ADDRESS: STREET S /1�� 7 e q CITY V ' � STATE L ZIP CONTRACTOR PHONE: I/S �i�� CONTRACTOR EMAIL: (�US , 1�� GC t�- I✓l�i 7 G� CONTRACTOR LIC.#(REQUIRED): U r 3S �� CITY OF EVERETT BUSINESS LIC,#(REQUIRED): =1139 PRIMARY CONTACT:! WOWNER P4 CONTRACTOR ❑OTHER(Please Specify) CONTACT NAME: CONTACT PHONE: kv CONTACT EMAIL: AGREEMENT.-Thereby ceifify that I have read and examined this application and know the same to be true and correct All provisions of laws nd ordinances governing this type of work will be completed whether specified herein ornot. 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 t am authorized by the owner of this property to perform the work for which application is made and/ comply with the State Contractors Law 98.27 RCW and 296.200 WAC. City of Everett Official Use Onfy FEE 2�m :7f :1 PERMIT# caner/Author d Agent Signature Date (Revised 10/92/2095)