Laserfiche WebLink
„....4 ELECTRICAL PERMIT APPLICATION <br /> 0.4 CITY OF EVERETT PERMIT SERVICES <br /> 411 .z., ./.. 3200 CEDAR STREET, EVERETT,WA 98201 <br /> (P)425-257-8810 1 FAX 425-257-8857 1 (E)everetteps@everettwagov[ www.everettwagov/permits <br /> PROJECT SITE INFORMATION <br /> PROJECT ADDRESS: ( (r)(3 D.. - \ 5-±- <br /> BUILDING AREA(if residential,new construction,remodel,or addition) SF <br /> BUILDING TYPE: 0 SFR-DETACHED 0 SFR-ATTACHED 0 DUPLEX 0 MULTI-FAMILY-#OF UNITS: 0 COMMERCIAL <br /> USE OF BUILDING: Ze,5 , <br /> -LECT' CAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK:$ 1 ci n 0 . 0 <br /> NUMBER OF DEVICES(if low v.tage): <br /> FIRE ALARM? 0 YES 0 NO <br /> ASSOCIATED BUILDING PERM ' #(if appti <br /> DESCRIPTION OF WORK: <br /> • <br /> CONTACT INFORMATION <br /> OWNER NAME:T)Clw A 1Y\c,..A C - (- TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET (g 00'', — r 5 E. <br /> CITY ‘7::' ‘41,4,rtAt- <br /> STATE VI P. ZIP Ci VZ D o3 <br /> OWNER PHONE: 'OWNER EMAIL: <br /> CONTRACTOR NAME: 07:0(_.- kti.Ack,irc, 4 7b.On& GI tejt"6 C..-- <br /> CONTRACTOR ADDRESS; STREET ?Cr-50X .q <br /> [ CITY Vib'AVM OA STATE <br /> I CONTRACTOR PHONE:43S-1-1S- tcii ICONTRACTOR EMAIL:A\ASei 11 t.VIVI,i.Ce r(DIfYCti‘,'cow.” <br /> CONTRACTOR LIC.#(REQU1RED): VIC 14.SE I a ta.tx !CITY OF EVERETT BUSINESS LIC.It(REcut-:i): 0(41'44 r <br /> PRIMARY CONTACT: 0 OWNER CONTRACTOR 0 OTHER(Please Specify) s <br /> CONTACTNAME CONTACT PHONE: ut.;.s - s- \cc i ci <br /> • <br /> CONTACT EMAIL: <br /> AGREE/i4ENT:I hereby certify that I have read and examined this application and know the same to be true and correct. RI 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 anyaller state or <br /> loc a I r regthul,efi:tceonstruchotobn orLathe pe'fonnancew a27 ofndcnonstru CThari am authorized by the owner of this property to perform the work for which application is made and! <br /> 6 20Cleff°17WA' <br /> , ' . • <br /> I <br /> t <br /> City of Everett Official Use Only <br /> PERMIT# <br /> E no2 -0(3 <br /> . • <br /> I <br /> LA <br /> [ 0 •r • ho'....CI •gent Signature Date (Revised 9/2312016) <br /> 11111ht, <br /> . <br />