Laserfiche WebLink
ELECTRICAL PERMIT r4PPLlCATION <br /> GTY OF EVERETT PERMiT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> (P)425-257-$�10 � FAX 425-257-8857 � (E) everetteps@everettwa.gov ( www,everettwa.gov/permits <br /> PROJECT SITE INFORMATtON <br /> PROJECT ADDRESS: �900 BrOaC�Wa / 380Q Rockefeiler <br /> BUILDING AREA(if residential. new construction,remodel,or addition) SF <br /> BUILDING TYPE: ❑ SFR-DETACHED ❑SFR-ATTACHED ❑ DUPLEX ❑ MULTi-FAMILY-#OF UNITS: ❑COMMERCIAL <br /> USE OF BUILDING: StaC�IUI�T) <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK: $ 5OO <br /> NUMBER OF DEVIGES (if Ic�w voita e : <br /> FIRE ALARPW? ❑YES ❑ NO <br /> ASSOCIATED BUILDING PERMIT#iif a licable : <br /> DESCRIPTION OF W�RK: COfifl@Ct el6Ctt'Of11C dl5p�ay t0 eXlStifl CIfCUt. <br /> CONTACT INFORMATION <br /> OWNER NAME:EVC'($tt SCF100I DlStfiCt TENAMT NAME if Commercial : EV@f@tt MePI'lOf1al StaCllUi'T'1 <br /> OWNER MAILING ADDRESS: src�E.�.-4��(� COIby AVe <br /> ,;,r�� Eve�ett ,,,;,E WA ,,,, 98203 <br /> OWNER PHONE: OWNER EMAlL: <br /> CONTRACTOR NAME: MlXlgtl I11C. C�ba SI101'@IIC18 Slgll Hc AWlllllg <br /> CONTRACTOR ADDRESS: ;ra�eT 12101 Huckleberry Lane <br /> t,,,,Ariington STATF WA Z,P 98223 <br /> CONTRACTOR PHONE: 360-4�5-20�3 GONTRACTOR EMAfL: �Y11CI(�Q SIIOf@Ilfl@SIgI1.COfil <br /> CONTRACTOR UC.#(REt]UiREp): SHORESA98Z'I W CITY OF EVERETT BUSINESS UC.#(REQUIREDl:0�092� <br /> PRIMARY CONTACT: ❑OWNER 0 CQNTRACTOft �OTHER(Please SpecifYl _.,� ____ __�___ <br /> CONTACT NAME: GONTACT PHONE: t}�5-4T'I-2H4Z <br /> MiCk Richards CONTAC7 EMAIL:rpjCl(tLSIlOfBIItI�Si n.com <br /> AGREEMENT:l hareby Ce�tfy that(have re8d and examinad this applicabe>n and tinvw ti�e same'o be t��z,e and corract A�i ta,ov;srons ollaws arrd ordrnances govemrn�lh,is ty��: <br /> �i/work will be cornpletad whefher s(>ecilied/ierein or not 1ho granting of a pvrmit dc;.:;n:�t presc:mE,to�:t•e au[hcriry to violate ur cr,nce!the p�ovisions�f;7ny OthQr sfale�r <br /> rocai law rcgulatinq construcC:on or the perfor�ttence of construction. That 1 am etRhonzr.d'oy rnu owre�of thr$pioper?y to nerf�im(h.�worR t�r whrr.h epp�icHUnr��s made e�xf f <br /> c.ornply wifh fhu Srate Contrectors Law 18.27 RCW end'196,2(10 WAG. <br /> City o/Evcrul!Offir,�af Use Oniy <br /> PERM1�IT# <br /> � _ � , E O �o� -b�� <br /> :�. .� ��. ;,,�_ , . <br /> OwnerlA horized Agent Signature nate jRews�d.9.�23/?016) <br />