3812 28TH PL NE 2017-10-30 - Laserfiche WebLink

ELECTRICAL PERMIT APPLICATION CITY OF EVERETT PERMIT SERVICES OL 3200 CEDAR STREET, EVERETT, WA 98201 (P)425-257-8810 FAX 425-257-8857 1 (E) everetteps@everettwa.gov I www.everettwa.gov/permits PROJECT SITE INFORMATION �j I PROJECT ADDRESS: BUILDING AREA(if residential, new construction, remodel,or addition) �� ' SF i BUILDING TYPE: El SFR-DETACHED 1:1 SFR-ATTACHED ❑ DUPLEX ❑ MULTI-FAMILY-#OF UNITS: COMMERCIAL I USE OF BUILDING: ELECTRICAL APPLICATION INFORMATION CONTRACT PRICE OF WORK: $ 1 cvpc NUMBER OF DEVICES if low volts e FIRE ALARM? ❑YES ❑ NO ASSOCIATED BUILDING PERMIT#(if applicable): DESCRIPTION OF WORK: i u CONTACT INFORMATION OWNER NAME: TENANT NAME(If Commercial): OWNER MAILING ADDRESS: STREET , pp JCS' CITU STATE ZIP 21P �tl(tel OWNER PHONE: �Z3- Z5g_ <�� OWNER EMAIL: CONTRACTOR NAME: 6 CONTRACTOR ADDRESS: STREET 3 [ Q C CRY STATE �,,\/Q,. ZIP CONTRACTOR PHONE: 'I Lv ,'((" t '/!; - I CONTRACTOR EMAIL: CONTRACTOR LIC.#(REQUIRED):�-Sf CITY OF EVERETT BUSINESS LIC.#(REQUIRED): PRIMARY CONTACT: ❑OWNER WCONTRACTOR ❑OTHER(Please Specify) CONTACT NAME: CONTACT PHONE: Td"-Cd t C_C" 7'."Vy'v/ CONTACT EMAIL: e9vLzc� l _ Cie" AGREEMENT/hereby certify that I have read and examined this application and know the same to be true and correct. All provisions of laws acid 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/ comply with the State Contractors Law 18.27 RCW and 296.200 WAC. i City of Everett Official Use Only - PERMIT# Owne"r/Authorized Agent Signature Date (Revised 9/23/2016) a ., I r, I