2720 RUCKER AVE 2017-10-25 - Laserfiche WebLink

ELECTRICAL PERMIT APPLICATION 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 PROJECTADDRESS: 2 2b O [A�.Q*'_ BUILDING AREA(if residentlal,new construction, remodel, or addition) SF BUILDING TYPE: ❑ SFR-DETACHED ❑SFR-ATTACHED ❑ DUPLEX ❑MULTI-FAMILY-#OF UNITS COMMERCIAL USE OF BUILDING: ELECTRICAL APPLICATION INFORMATION CONTRACT PRICE OF WORK: $ c) ,«' NUMBER OF DEVICES if low volta e): FIRE ALARM? ❑YES ❑ NO ASSOCIATED BUILDING PERMIT t (if a licable): DESCRIPTION OF WORK: �Dt-�V- k04 LqA_ - �.. #r- v CONTACT INFORMATION OWNER NAME: Ch—A&L ( �'.�{,(✓I; TENANT NAME(If Commercial): OWNER MAILING ADDRESS: STREET cm STA?E ZIP OWNER PHONE: L42 Z 9 1040 1OWNER EMAIL: CONTRACTOR NAME: 0 CONTRACTOR ADDRESS: s1REETQ ( ^'yy CITY "-"" STATE A _ ZfG' .✓01 CONTRACTOR PHONE: 6_6 CONTRACTOR EMAIL: " > VIYI` CONTRACTOR LIC.if(REfaUlRED1:U11h Zd''i CITY OF EVERETT BUSINESS LIC.#(REQUIRED): PRIMARY CONTACT: ❑OWNER PkCONTRACTOR ❑OTHER(Please Specify) CONTACT NAME: CONTACT PHONE: �5� i CONTACT EMAIL: t Y t ! .COIn AGREEMENT:I hereby certify that t have read and examined this application and know the same to be 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 Oficial Use Only PERMIT# �l o OwnertAuthorized Agent Signature Date (Revised 9/23/2016)