1712 CALIFORNIA ST 2017-09-08 - Laserfiche WebLink

WECTRICAL PERMIT Af LICATION EV 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 PROJECT SITE INFORMATION PROJECT ADDRESS: !_ Q BUILDING AREA(if residential, new construction, remodel, or addition) SF BUILDING TYPE: ❑ SFR-DETACHED ❑ SFR-ATTACHED ❑ DUPLEX ❑ MULTI-FAMILY-#OF UNITS: f COMMERCIAL USE OF BUILDING: ELECTRICAL APPLICATION INFORMATION CONTRACT PRICE OF WORK: $ -60 NUMBER OF DEVICES (if low voltage): FIRE ALARM? ❑ YES XNO ASSOCIATED BUILDING PERMIT# (if appli able): DESCRIPTION OF WORK: CONTACT INFORMATION OWNER NAME: v e Pi TENANT NAME(If Commercial): OWNER MAILING ADDRESS/ STREETelvo, e (/ _ CITY (/ STATE ZIP �0 OWNER PHONE. OWNER EMAIL: CONTRACTOR NAME: CONTRACTOR ADDRESS: STREET ,ZgU CITY G STATE - ZIP CONTRACTOR PHONE: CONTRACTOR EMAIL: Cf C 1, C 0 CONTRACTOR LIC.#(REQUIRED): O CITY OF EVERETT BUSINESS LIC.#(REQUIRED): C� :3 PRIMARY CONTACT: ❑ OWNER CONTRACTOR ❑ OTHER (Please Specify) CONTACT NAME: CONTACT PHONE: 2 CL170ynCONTACT EMAIL: vchg pp/ e ,Coln AGREEMENT.Thereby certify that I have read and examined this application and know the same e true and correct. All provisions of laws and 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 am authorized 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 FEE PERMIT# _ a E er/Aut orized Agent Signature Date (Revised 10/12/2015)