4125 GRAND AVE 2018-01-18 - 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: ��i � ' i��' � BUILDING AREA(if residential, new construction, remodel, or addition) ��-tJ' S BUILDING TYPE: � SFR-DETACHED ❑ SFR-ATT�ACHED ❑ DUPLEX ❑ MULTI-FAMILY #OF UNITS: ❑ OMMERCIAL � �'� aa•.�t_.�_..��..�--�_ •`_- USE OF BUILDING: --- ECTRI AL APPLICATION INFORMATION CONTRACT PRICE OF WORK: $ '�-! �' NUMBER OF DEVICES (if low voltage)I FIRE ALARM? ❑YES NO ASSOCIATED BUILDING PERMIT#(if lic e): C �1 ' �% Z 5 DESCRIPTION OF WORK: C�J (�l' �C/��l1 l�u 5(= CONTACT INFORMATION OWNER NAME: �c9 �-� �/1'�+'1(is (i(� TENANT NAME(If Commercial): OWNER MAILING ADDRESS: srHeET CITY STATE ZIP OWNER PHONE: OWNER EMAIL: CONTRACTOR NAME: �� / .��Trs--��j�l✓✓ �=L��772��i (nJ�-- CONTRACTOR ADDRESS: srReer � 3 L Z � 3 Z"`� 5 T , �/ '/j � . U CITY L N/U WC�� STATE ZIP CONTRACTOR PHONE: V� �3 �d� � � CONTRACTOR EMAIL: e.Q G �� W � ��c � ��//� CONTRACTOR LIC.#(REQUIRED):�C ��'%�,E_L. a G C� ,8 �- CITY OF EVERETT BUSINESS LIC.#(REQUIRED.O 3 7 Z.3 O PRIMARY CONTACT: ❑OWNER �CONTRACTOR ❑OTHER(Please Specify) � _ CONTACT NAME: CONTACT PHONE: �/¢j�r� ��✓�� CONTACT EMAIL: �j¢� � AGREEMENT:1 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 tF,�is 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 sfate or local law regulating construcfion or the pertormance of construction. That 1 am authorized by the owner of this property to pertorm the work for which application is made and 1 comply with the State Contractors Law 18.27 RCW and 296.200 W,4C. City of Everett Official Use Only PERMIT# �,, - E ��, � l�.��-- Owner/Authorized Agent Signature Date (Revised 9/23/2016)