1513 107TH PL SW 2018-04-25 - Laserfiche WebLink

ELECTRICAL PERMIT APPLICATION CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET, EVERETT, WA 98201 (P)425-257-8810 � FAX 425-257-8857 � (E) everetteps@everetiwa.gov� www.everetfinra.gov/permits ' PROJECT�SITE INFORMATION _ _ _ _>. .. . _ ; , PROJECT ADDRESS: ` � 3 . d � r S�, ,,E{��r�' �'a C),T BUILDING AREA(if residential, new construction, remodel,or addition) SF � BUILDING TYPE: ❑SFR-DETACHED .C�11 SFR-ATTACHED ❑ DUPLEX ❑ MULTI-FAMILY-#OF UNITS: ❑COMMERCIAL USE OF BUILDING: : �. . � ,, ; ;. ;� �; ' ELECTRICAL APPLICATI�ON 1NFORMATION :' CONTRACT PRICE OF WORK:$ ' a� NUMBER OF DEVICES (if low voltage): FIRE ALARM? ❑YES ,�NO ASSOCIATED BUILDING PERMIT#(if applicable): DESCRIPTION OF WORK: /�e,r,�/ (,� , r � CONTACT INFORMATION . � .� � ,, � OWNER NAME: �� "��r,t S TENANT NAME(If Commercial): OWNER MAILING ADDRE S: sTReer /� �y� -� cirv �'✓�P�`� sra,Te F�((/c�. zia Y��C� OWNER PHONE: OWNER EMAIL: CONTRACTOR NAME: � � �-G CONTRACTOR ADDRESS: s-raeer � � / `^ Sf• S u� CITY �..�� f� STATE ZIP /�Ua^� CONTRACTOR PHONE: CONTRACTOR EMAIL: �GCY C� �- � � CONTRACTOR LIC.#(REQUIRED): �j^ (� ,� s� f �,3 '('h CITY OF EVERETT BUSINESS LIC.#(REQUIRED): . �. . , � ,� . ___..... ... ___ .. .....,.�_�.. �_.... ._ .. .....�_._ ...,.. �.b_,...._ . .,._ ._ �...,.,..... _....e..:...,, . ..., �,:, t,.v�,..._ ,.._._... _.,.�.�,_:..,,:...... PRIMARY CONTACT: �„OWNER ❑CONTRACTOR ❑OTHER(Please Specify) CONTACT NAME: CONTACT PHONE: �,� -rj- 3� .-- '�b ,j� �a�/P "('��{S � CONTACT EMAIL: AGREEME :T hereby certify that I 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 spec�ed 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 consfruction. That I am authorized by the owner of this property to perform fhe work for which applicafion is made and I comply with the State Contractors Law 18.27 RCW and 296.200 WAC. City of Everett Official Use Only FEE �� O� fr�-� � ` � PERMIT# ° :�.-- �i� ; /� E 1� ��1�' l2� Owner/Authorized Agent Signat Date (Revised 10/12/2015)