915 N BROADWAY WSU 2018-11-21 - Laserfiche WebLink

E'�CTRICAL PERMIT AP�ICATION 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: ��I /v. .Q/-d tt c�i�/a BUILDING AREA(if residential, new construction, remodel, or addition) /DOO SF BUILDING TYPE: ❑ SFR-DETACHED ❑ SFR-ATTACHED ❑ DUPLEX ❑ MULTI-FAMILY-#OF UNITS: I�COMMERCIAL USEOFBUILDING: Go/�C G G�`7Js f'oe�-j,�' ELECTRICAL APPLICATION INFORMATION CONTRACT PRICE OF WORK: $ 9i Z8S? �° NUMBER OF DEVICES (if low voltage): FIRE ALARM? �YES ❑ NO ASSOCIATED BUILDING PERMIT# (if applicable): DESCRIPTION OF WORK: /�/�� -qc�yo,�/ �cr�c �'/o„� y�� o .� t �c v c - /.� S/ , a i�- d c � s � � A � CONTACT INFORMATION OWNER NAME: Lc,/SC/ TENANT NAME (If Commercial): OWNER MAILING ADDRESS: srREET /�D, �BoX 6 fr3 6// CITY / u//fiQ� STATE !��7 ZIP /O IO OWNER PHONE: .Sd 9'- 335� yf 3 OWNER EMAIL: CONTRACTOR NAME: Co�/yCt /„�f T�c �vd�o /t'.J CONTRACTOR ADDRESS: sTReEr SO Q�� G �. .s- CITY �C�A/fO^I STATE �� ZIP 9C OS� CONTRACTOR PHONE: ZS�Z6 y f�,36 6 CONTRACTOR EMAIL: �GwJ �a�cr � c�,uyer ' �. CONTRACTOR LIC.#(REQUIRED): Q vETL S CITY OF EVERETT BUSINESS LIC.#(REQUIRED):D�/ZLL PRIMARY CONTACT: ❑ OWNER �CONTRACTOR ❑ OTHER(Please Specify) CONTACT NAME: CONTACT PHONE: yZS- z�y 93c6 ,�CN �JaK«- CONTACT EMAIL: k��. �a�c � o �' AGREEMENT:T hereby certify that 1 have read and examined this appGcation and know the same to be true and correct. All provisions 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 authonty to violate or cancel the provisions of any other state or local law regulating construction or the performance of construction That 1 am authorized by the owner of this property to perform the work for which application is made and 1 comply with the Sfate Contracfors Law 18.27 RCW and 296.200 WAC. City of Everett Official Use Only FEE ��_�� 1 � �� l PERMIT# � �.�� 9�� E ��0� ' I�� Owner/Authorized Agent Signature Date (Revised 10/12/2015)