Laserfiche WebLink
• • <br /> ELECTRICAL PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> (P) 425-257-8810 I FAX 425-257-8857 I (E) everetteps@everettwa.gov I www.everettwa.gov/permits <br /> PROJECT SITE INFORMATION <br /> PROJECT ADDRESS: L j& <br /> BUILDING AREA(if residential, new construction, remodel, or addition) G t t/ f C- SF 1-71X) <br /> BUILDING TYPE: El SFR-DETACHED ❑ SFR-ATTACHED 0 DUPLEX ❑ MULTI-FAMILY-#OF UNITS: ❑ COMMERCIAL <br /> USE OF BUILDING: Gctvc.q c_ <br /> / ECTRICA APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK: $ <br /> NUMBER OF DEVICES (if low voltagei: <br /> FIRE ALARM? ❑YES _. • <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIPTION OF WORK: Ca (� G�/f x171 i S Cc (/' fd r` <br /> CONTACT INFORMATION <br /> OWNER NAME: )Ot 'I l0(,{/L( Cud' -e-V TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET p �� � <br /> c' -CP <br /> CITY gL e r./ STATE 1.444-- <br /> ' ZIP <br /> OWNER PHONE:L/ S S `f'/��(-7"{1]' OWNER EMAIL: <br /> CONTRACTOR NAME: ,Dq� v /t Ct('I C <br /> CONTRACTOR ADDRESS: STREET caC JO r ' S�3O <br /> CITY kri,k k {� STATE w 4 ZIP Fa <br /> CONTRACTOR PHONE:9 j` 13 q ` 5r3) 6 CONTRACTOR EMAIL: ci c(,f fFie(.ed(1 l �ye'yt L, <br /> CONTRACTOR LIC.#(REQUIRED):17jr - KtC CITY OF EVERETT BUSINESS LIC.#(REQUI"D): 0e3_ <br /> PRIMARY CONTACT: 0 OWNER lit CONTRACTOR 0 OTHER(Please Specify) / <br /> CONTACT NAME: i) �'-�-r,v D f-'01-1) CONTACT PHONE: L/LS —;)3(� S-3 l <br /> CONTACT EMAIL: cicA,A.lepY e ( kha. <br /> AGREEMENT.I hereby certify that/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 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 the work for which application is made and I <br /> comply with the State Contractors Law 18.27 RCW and 296.200 WAC. <br /> City of Everett Official Use Only <br /> PERMIT# <br /> /21V 12 E q-oCe —0(c2 <br /> Owner/Authorized Agent Signature Date (Revised 9/23/2016) <br />