319 76TH PL SW 2018-04-25 - Laserfiche WebLink

ELECTRICAL PERMIT �PLICATION CITY OF EVERETT PERMIT SERVICES ,� 3200 CEDAR STREET, EVERETT,WA 98201 �; � ��) 25-257-8810 � FAX 425-257-8857 � (E) everetteps@everettwa.gov � www.everettwa.gov/permits ��.,� � ,�3 PRO��C7'S1TE 1NFORM�'i"IaN PROJECT ADDRESS: BUILDING AREA(if residential,new construction, remodel,or addition) SF BUILDING TYPE: SFR-DETACHED ❑SFR-ATTACHED ❑ DUPLEX ❑MULTI-FAMILY-#OF UNITS: �COMMERCIAL USE OF BUILDING: ELECTRICAL APPi.1CA"�ION INFORIV�ATION. ; CONTRACT PRICE OF WORK:$ NUMBER OF DEVICES if low voita e : FIRE ALARM? ❑YES ❑NO ASSOCIATED BUILDING PERMI # if licable : DESCRIPTION OF WORK: L VL ./( t� CONTACT INFORMATION OWNER NAME � _ �J TENA NAME(If Commercial): OWNER MAILING ADDRESS: sraeer ! C�T�' STATE ZIP � OWNER PHONE: OWNER EMAIL: CONTRACTOR NAME: � CONTRACTOR ADDRESS: STREET CITY STATE � ZIP � C '� CONTRACTOR PHONE: � ACTOR EMAIL: _- � „ , CONTRACTOR LIC.#(REQUIRED): � , M CITY OF EVERETT BUSINESS LIC.#(REQUIRED): C Z' PRIMARY CONTACT: ❑OWNER CONTRACTOR ❑OTHER(Please Specify) CO TACT NAME: ` CONTACT PHONE: � . - � � � �.(�� ( Z CONTACT EMAIL: AGREEMENT.•T hereby certify that 1 have read and examined this application and know the same to be true and correct. All provisions of laws and ordinances governing this rype of work will be completed whether specifled herein or not. The granting of a pe�mit does not presume to give authority to violate o�cancel the provisions of any other state or loca!!aw regulating construction or the performance of construction. That l am authorized by the owner of this property to perform the work for which application!s made and l comply with the Siate Contractors Law 18.27 RCW and 296.200 W,4C. City of Everett Official Use Only FEE �� _ � PERMIT# � E 1 �2 -01 � Owner/Authorized �tu e Date (Revised 10/i2/2015)