Laserfiche WebLink
LLECTRICAL PERMIT APr`ICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> (P) 425-257-8810 � FAX 425-257-8857 � (E) everetteps@everettwa.gov � www.everettwa.gov/permits <br /> PROJECT SITE INFORMATION <br /> PROJECT ADDRESS: Z Z C% ,�G, �V�e�E%"�' ��C�` uJ�-i L �-�-�'z r/ �, � � D ZG p <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: S@NIC2 StatlOfl�COt1V@Ill@f1C@ StOf @ <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK: $ ��. � � <br /> NUMBER OF DEVICES (if low voltage): <br /> FIRE ALARM? ❑YES m NO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIPTION OF WORK: ��,f;�i�i� � 3 � �.�,� � ' -/"S � t- � �,�. <br /> F.✓q l� , h � <br /> J`°- <br /> c-� f��' .. .o' ��ei�fZt�'� ��C> � � <br /> /1� -r <br /> CriT�2 Z?'Qclu� ' �� r <br /> >.. C'E!� / J ��r' �i' ' �O � L�' I� _ <br /> CONTACT INFORMATION <br /> OWNER NAME: �/��1 11�1�V�1 (�"j'� 1.TENANT NAME(If Commercial): S�+"1 W� <br /> OWNER MAILING ADDRESS: srReer (� �L— (�V ii��� �'✓�J�L � W�� <br /> CITY �V��� STATE ��� ZIP �,���- <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: �`v `� -I S j �_ — ��������/rt�— �L� <br /> CONTRACTOR ADDRESS: srREeT � � /VF f t <br /> > <br /> GTY � �f// i STATE �✓� ZIP � ���S � <br /> CONTRACTOR PHONE: zU ., - '3'Z � •� " (,� CONTRACTOR EMAIL• <br /> CONTRACTOR LIC.#(REQUIRED): ' , �-� ` fi� (;� - CITY OF EVERETT BUSINESS LIC.#(REQUIRED): 5� <br /> PRIMARY CONTACT: ❑OWNER ONTRACTOR ❑ OTHER(Please Specify) <br /> CONTACT NAME: �yj_ � ,yr � � CONTACT PHONE: �7 G <br /> � Gi,T' 1 � ��5.,•.�i.S�i� (�U �^ " � '� " � ..J <br /> CONTACT EMAIL: :�,r��� � . ,r�.l'�S ' �i.�' _ Y(� �� G6 <br /> AGREEMENT. 1 hereby certify that 1 have read and examined this application and know the same to be true and correcf. All provisions of laws and ordfnanCes governing this type <br /> of work will be completed whether specified herein or not. The granting of a permit does not presume to give authonty to violate or cancel fhe provrsions of any other state or <br /> loca!law regulating constructron or the pertormance of construction. That 1 am authorized by the owner of this property to pertorm the work for which application is made and 1 <br /> comply with the State Contractors Law 18.27 RCW and 296.200 WAC. <br /> City of Everett Official Use Oniy <br /> PERMIT# <br /> - �Jc r �� « � �- E ��� �`- �� � �1,. <br /> Ow r uthorized Agent Signature Date (Revised 9/23/2016) <br />