11031 19TH AVE SE 2018-02-27 - Laserfiche WebLink

ECTRICAL PERMIT AP .ICATION 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 www.everettwa.gov/permits PROJECT SITE INFORMATION PROJECT ADDRESS: tit 6 3 \ct° V\yQ, 9,.E . BUILDING AREA(if residential,new construction,remodel,or addition) SF BUILDING TYPE: 0 SFR-DETACHED ❑ SFR-ATTACHED 0 DUPLEX 0 MULTI-FAMILY-#OF UNITS: (COMMERCIAL USE OF BUILDING: uJG.y ELECTRICAL APPLICATION INFORMATION CONTRACT PRICE OF WORK:$ -ZAA p I> NUMBER OF DEVICES(if low voltage): FIRE ALARM? 0 YES X10 ASSOCIATED BUILDING PERMIT S(if applicable): DESCRIPTION OF WORK: 1-1 ottoa 1 j,axe CONTACT INFORMATION OWNER NAME: TENANT NAME(If Commercial): OWNER MAILING ADDRESS: sTREEr CITY STATE ZIP OWNER PHONE: OWNER EMAIL: CONTRACTOR NAME: 40 ori g $\o cae, CONTRACTOR ADDRESS: STREET SLIM \"ap CITY s K i[.r STATE Wile ZIP CONTRACTOR PHONE 253 Cagy CONTRACTOR EMAIL: a un Q.0ba.c,",.5e1st c`YQ�.Q,1La-.wrr,►, CONTRACTOR LIC.#(REQUIRED): ()c 0 CC 3..c1'S LT CITY OF EVERETT BUSINESS LIC.#(REQUIRED): (j 4 3 t PRIMARY CONTACT: D OWNER CONTRACTOR 0 OTHER(Please Specify) CONTACT NAME: CONTACT PHONE:Q6 3,ctx tlo�t Oi\ Mairrit.AVI�f1 CONTACT EMAIL:ca..,forx 0200..L.t e_s, te3.0...kva_ Y-ti AGREEMENT:T hereby certify that t 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 I am authorized by the owner of this property to perform the work for which application is made end I comply with the State Contractors Law 18.27 RCW and 296.200 WAC. City of Everett Official Use Only FEE \r-D PERMIT# r N"' (0-C)D') .9 Ece(p- Owner/Authorized Agent Signature Date (Revised 10/12/2015)