Laserfiche WebLink
ALECTRICAL PERMIT APORICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> (P)425-257-8810 FAX 425-257-8857 1 (E) everetteps@everettwa.gov I www.everettwa.gov/permits <br /> PROJECT SITE INFORMATION <br /> PROJECT ADDRESS: -:'-Lf <br /> BUILDING AREA(if residential, new construction, remodel, or addition) SF <br /> BUILDING TYPE: RrSFR-DETACHED ❑ SFR-ATTACHED ❑ DUPLEX ❑ MULTI-FAMILY-#OF UNITS: ❑COMMERCIAL <br /> FSE OF BUILDING: <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK: $ <br /> NUMBER OF DEVICES (if low voltage): <br /> FIRE ALARM? ❑YES N NO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIPTION OF WORK: j - s '�J'N LL- I r_Ua act t-"t'k <br /> R,F- Si a- 13' - %7C-; <br /> Ab(]) j2 j,C_ L r Cx-F S L4 r/ kj G I�.J <br /> CONTACT INFORMATION <br /> OWNER NAME: M k_G T C?Njk i 6Z TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET '4'0 ' PC-Lid- LLtll L. A,jr-- <br /> CITY /- V!2 1 z1:.-' j STATE 4v ZIP y 8 LL• <br /> OWNER PHONE: 70�Ib OWNER EMAIL: <br /> CONTRACTOR NAME: t q �1 l k L Q- t`q <br /> CONTRACTOR ADDRESS: STREET 3 <br /> CITY {=•V(;�:: N STATE Ju(� ZIP u��••-lJ <br /> CONTRACTOR PHONE: ,y� �„- <br /> � �-' GCJ �'3 CONTRACTOR EMAIL: ° �-f=tri�l�.�'�,. L (-1t1,.IL <br /> CONTRACTOR LIC.#(REQUIRED): rA L L3���:,�,"�?� �.` .� CITY OF EVERETT BUSINESS LIC.#(REQUIRED): 0 3831f O <br /> PRIMARY CONTACT: ❑OWNER 1K CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: S' <br /> +11 1< i- t'f'i t t_V c-.► CONTACT EMAIL: S kt-A <br /> CF- <br /> AGREEMENT:Thereby certify that/have!dead and examined this application and know the same to be true and correct. All provisions of laws and ordinances governing this <br /> 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 <br /> 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/ <br /> comply with the State Contractors Law 18.27 RCW and 296.200 WAC. <br /> City of Everett Official Use Only <br /> FEE <br /> l�Ju r� <br /> PERMIT# <br /> Owher/Au horized Agen�S'i fiatur "—" Date (Revised 10/12/2015) <br /> 1 <br />