6105 CADY RD 2018-02-23 - Laserfiche WebLink

ELECTRICAL PERMIT APPLICATION _ CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET, EVERETT, WA 98201 (P) 425-257-8810 I FAX 425-257-8857 I (E)everetteps@everettwa.gov I www.everettwa,gov/permits PROJECT SITE INFORMATION PROJECT ADDRESS: hI V5 O3_c&.t3. Rd BUILDING AREA(If residential, new construction,remodel,or addition) SF BUILDING TYPE: 0 SFR-DETACHED ❑ SFR-ATTACHED 0 DUPLEX ❑MULTI-FAMILY-#OF UNITS: 0 COMMERCIAL USE OF BUILDING: ELECTRICAL;'APPLICATION1NFORMAt ON CONTRACT PRICE OF WORK: $ 250 ,c' NUMBER OF DEVICES (if low voltage): FIRE ALARM? ❑YES 0 NO ASSOCIATED BUILDING PERMIT#(if applicable): DESCRIPTION OF WORK: g P(OLQ c3a,S ` rylC c� 4) CONtACT iNFoRMAtloN OWNER NAME: L(V1 1ry�;+j(S"r'( TENANT NAME(If Commercial): OWNER MAILING ADDRESS: STREET !0 6 eariAjRd +�/1y �/ CftY ' W STATE / ZIP 2J OWNER PHONE:425 YS 4 ??7 OWNER EMAIL: CONTRACTOR NAME: C '+t Ni-C[. 1t C CONTRACTOR ADDRESS: STREET L115 WO ad CITY ""'b+l STATEA- ZIP (i 201 CONTRACTOR PHONE: 5� ci OTh CONTRACTOR EMAIL: deovse + G ll - lag r CONTRACTOR LIC.#(REQUIRED):CXYl 1e 1'l%11dr't CITY OF EVERETT BUSINESS LIC.#(REQUIRE T:IL Q PRIMARY CONTACT: 0 OWNER CONTRACTOR 0 OTHER(Please Specify) CONTACT NAME: CONTACT PHONE: ti,R5q {, Wale ,e CONTACT EMAIL: tw Vicom corn 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 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 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 I comply with the State Contractors Law 18.27 RCW and 296.200 WAC. City of Everett Official Use Only PERMIT# Feb/24.- 12-20.17 E 1 t2 Owner/Authorized Agent Signature Date (Revised 9/23/2016)