Laserfiche WebLink
�ECTRICAL PERMIT AF�ICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> _ ��l�-?�-25?-�31� � FAX4�5�2�7-�3�,�? .� (E� e��er�#���c!^�a�JP,r2ii�W8.gOL� � www.everettwa.cc�v!permit� <br /> PROJECT SITE INFORMATION <br /> PROJECT ADDRESS: '�C% i�: � K�� �L��t�.���� <br /> BUILDING AREA(if residential, new construction, remodel,or addition) ���' SF <br /> BUILDING TYPE: SFR-DETACHED ❑ SFR-ATTACHED ❑ DUPLEX ❑ MULTI-FAMILY-#OF UNITS: ❑ COMMERCIAL <br /> USE OF BUILDING: L.%ti?F-'��A'T��"j 1��C=.� <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK: $ '�j, Z 7��`C=' <br /> NUMBER OF DEVICES if low volta e : l�.q • <br /> FIRE ALARM? ❑YES [iI�NO <br /> ASSOCIATED BUILDING PERMIT# if applicable : <br /> DESCRIPTION OF WORK: �'1�' � I �„W • ���(' • ` a�-ca t ca r�� . � � � �?�- <br /> ``�j U b C �' , i Y1•�c !�l' �I � T5 �i►1� C�'�3� �-�5_ <br /> CONTACT INFORMATION <br /> OWNER NAME: l:f�{Z.L �j�EE L,"�9 TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: srrzeeT `2.� I K� ;�T �,.�� <br /> CfTV � � ( STATE �I h'F' ZIP �� � <br /> OWNER PHONE: Z�- f�� � ' OWNER EMAIL: cGt('I�, ��{'G�d�� �'Y1L�� � L-�1'�''� <br /> CONTRACTOR NAME: �� )� `� —LE � � �� <br /> CONTRACTORADDRESS: srreEET � i - �'�I ��OJ'��r� �j� <br /> CITY S�C��V� �SC STATE ZIP ����� <br /> CONTRACTOR PHONE: (p(� `– ��(. CONTRACTOR EMAIL: � � F* '�I�1�1 � ���E-'c":-�T'1 t_( (Ce 12c�� <br /> CONTRACTOR LIC.#(REQUIRED):�� � ��� CT � 12�,J' CITY OF EVERETT BUSINESS LIC.#(REQUIRED): Z� <br /> PRIMARY CONTACT: ❑ OWNER CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: ° - ���- J�'xj� <br /> Jt•�'�`�F�Z�-� CONTACT EMAIL: � � � --�-f-1'(�� �CC:�TriC� I 1 G7� 1'lS�,'� <br /> AGREEMENT:T hereby certify that I have read and examined this app/ication and know the same o be true and correct. All provisions of laws and ordinances goveming 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 fhe work for which application is made and 1 <br /> comply with fhe Sfate Contractors Law 18.27 RCW and 296.200 WAC. <br /> City of Everett Official Use Only <br /> FEE <br /> ��� � <br /> PERMIT# <br /> � z4 �.�►� E � C� � �� - ��,''�� <br /> Owne Auth riz d Agei�t Si ature ate (Revised 10/1212015) <br />