10127 21ST AVE W 2018-01-11 - Laserfiche WebLink

• • ELECTRICAL PERMIT APPLICATION CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET, EVERETT, WA 98201 (P) 425-257-8810 � FAX 425-257-8857 � (E) everetteps@everettwa.gov � www.everettwa.gov/permits PROJECT SITE INFORMATION PROJECT ADDRESS: `r_"�/ ,2 �' «� /Z�/� � BUILDING AREA(if residential, new construction, remodel, or addition) S�� SF �L' C� BUILDING TYPE: ❑SFR-DETACHED ❑ SFR-ATTACHED ❑ DUPLEX ❑ MULTI-FAMILY-#OF UNITS: ❑ COMMERCIAL USE OF BUILDING: � ��1��=; ELECTRICAL APPLICATION INFORMATION CONTRACT PRICE OF WORK: $ �� NUMBER OF DEVICES (if low voltage): FIRE ALARM? ❑YES ❑ NO ASSOCIATED BUILDING PERMIT#(if applicable): DESCRIPTION OF WORK: , �G� CONTACT INFORMATION OWNER NAME: �j/�,�i ��a/�r>.//l�'f"/%.� TENANT NAME(If Commercial): OWNER MAILING ADDRESS: srReer l � 2��.�YC Y� � /Q L �� {� ciTv Y'�/� STATE %��,ZD�P OWNER PHONE: OWNER EMAIL: CONTRACTOR NAME: CONTRACTOR ADDRESS: sTReer CITY STATE ZIP CONTRACTOR PHONE: CONTRACTOR EMAIL CONTRACTOR LIC.#(REQUIRED): CITY OF EVERETT BUSINESS LIC.#(REQUIRED): PRIMARY CONTACT: OWNER ❑CONTRACTOR ❑OTHER(Please Specify) CONTACT NAME: i y� � CONTACT PHONE: � �� C%�� v CONTACT EMAIL: AGREEMENT:T hereby certify that l have read and examined this application and know the same to be true and conect. Al!provisions of/aws and ordinances governing this type of work will be complefed whether specified herein or nof. The granting of a permit does not presume to give authority to violate or cancel the provisions of any ofher state or local law regulating construction or the performance of construction. That I am authorized by the owner of this property to pertorm fhe work for whrch application is made and! comp/y with the State Contractors Law 98.27 RCW and 296.200 WAC. City of Everett Official Use Only FEE � � •� � PERMIT# /� �� %� E l � - D(�J,' O ner/Au or" gent Signature Date (Revised 10/12/2095)