Laserfiche WebLink
�ECTRICAL PERMIT AP�ICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> (P)425-257-8810 � FAX 425-257-8857 � (E)everetteps@everettwa.gov � www.everettwa.gov/permits <br /> PROJECT SITE INFORMATION <br /> PROJECT ADDRESS: ��� I j �� �(��� �j� <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: ���--- <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK: $ �j�S <br /> NUMBER OF DEVICES (if low voltage): <br /> FIRE ALARM? ❑YES ;�$LNO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIPTION OF WORK: /Oad M� l (�sI�-C,1,�!� ���.- ���G-�SS -/�J (//� <br /> CONTACT INFORMATION <br /> OWNER NAME: � `� `f' F <br /> �O/✓ �l G�, �; TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: srReeT ��I j �ZN �i�� � <br /> CIIY C/v���i�, STATE �f " � ZIP �l> ZO <br /> OWNER PHONE: `1� '3��'����I� OWNER EMAIL: <br /> CONTRACTOR NAME: (,/P IV/Ji�4�Cl�. �/'!�—' � S�t�tl/'����j <br /> CONTRACTOR ADDRESS: srREEr �/�L l !r N� f� <br /> CITY ��7 f���J/ STATE �� ZIP `^ C� � � <br /> CONTRACTORPHONE: `i ZS--�'/�C"��/p(t�� CONTRACTOREMAIL: (,��✓D!�'NG�F,�l�l� � �✓l-,s'N.. CbJ� <br /> CONTRACTOR LIC.#(REQUIRED): j(.L•r`J�A��OC���� CITY OF EVERETT BUSINESS LIC.#(REQUIRED): ��S Z <br /> PRIMARY CONTACT: ❑ OWNER �CONTRACTOR ❑ OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: �'7r� — �( �(6,(�j CJ <br /> l��l�N �,r,��i� . <br /> CONTACT EMAIL: ,/�/lJ,(�����/�fj„� ' �/r,ilj'r✓,Gc��(, <br /> AGREEMENT:I hereby certify that I have read and examined this application and know the same to be true and correct. All provisions of laws and ordinances governing this type <br /> of work will be completed whether specified herein or not. The granting of a permit does not presume to give authority to vio/ate or cancel the provisions of any other state or <br /> local law regu/ating constructron 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 <br /> comply with fhe State Contractors Law 18.27 RCW and 296.200 WAC. <br /> City of Everett Official Use Only <br /> PERMIT# <br /> i�--1�-�� E ��< < -- �S <br /> Owner/Authorize Agent S" n ure Date (Revised 9/23/2016) <br />