801 75TH ST SE 2018-04-25 - Laserfiche WebLink

�.ECTRICAL PERMIT A�ICATI�N CITY C)F EVERETT PERMIT SERVICES 3200 CEDAR STREET, EVERETT,WA 98201 (P)425-257-8810 � FAX 425-257-8857 � (E)everetteps@everettwa.gov� www.everettwra.gov/permits _ __ _ _ - ___ __ _ � .� " . ;� � ��.;. ": ;�� '�; ;, . :?. PRt?�E�T SITE lN�ORMAT�ON��; �� PROJECT ADDRESS: • � "� �Ik� ` �. BiJiLDING AREA(if residential,new struction,remodel,or addition) � � SF BUIIDING TYPE: �SFR-DETACHED ❑SFR ATTACHED ❑ DUPLIX MULTI-FAMILY-#OF UNITS: �COMMERCIAL USE OF BUILDING: ` v EG�CTRICAL dPPL1C=ATN�i+t%;It�FORM,ATION I CONTRACT PRICE OF WORK:$ NUMBER OF DEVICES(if low volta e : FlRE ALARM? ❑YES NO ASSOCIATED BUILDING PERMIT# if a licable : ---- __ - _ , _ _ . DESCRIPTION OE WORK: ,$�`�p ��, � � O� $��0 �4 \ �W \� h,'r � . . . � r � � . . � .. � . . . . C�NTI�+CT INF�R1YlAT10N OWNER NAME: Vt l �Q,. TENANT NAME If Commer+rslal}; �. OWNER MAILING ADDRESS: s�er Q� ST � O C(TY STATE ZIP Q OYItNER PHONE: � Q OWNER EMAIL: _. _ . _ CONTRACTOR NAME• '� � , � C CONTRACTOR ADDRESS: srneer ` �, �.��1n � � CITY STATE ZIP CONTRACTOR PHONE: �� CONTRACTOR EMAfL: • � � � ` CONTRACTOR LIC.#(RE(2UIRED): � � GtN OF BUSINESS L1C.#(REQUIRED):- . _ , . PRIMARY CONTQGT: ❑OWNER ONTRACTOR 0 OTHER(Pleass Specify) CONTACT NAME: CON7ACT PHONE: a` � � GONTACT EMAIL- AGREEMENT.�T hereby ce at!have read and examined this appilcatior+and know the same to beYrue and correct. Al1 provisions of laws and ordinances goveming this type of work will be comp/eted wfrefher specifred he�in or not. The granSng of a perm8 does not presume to give authwify to violate or cance!the provisionsof any other state or loca/law regulating corrstruction or ti�e perfomiance of consbuction. That l am authorized by the owner of this property to perforrn the work far which appCrcetan u made and i comp/y with fhe State Confractors Law 18 27 RCW and 296.200 WAC. City of Eve�tt Otfrciat Use OMy FEE � �� •�f PERMIT# a ,� E �� - ��l Owner! n Signature Date (Revised 10/12/2a15)