1913 FAIRFAX AVE 2018-05-15 - Laserfiche WebLink

ELECTRICAL PERMIT APPNCATION CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET, EVERETT, WA 98201 (P)425-257-8810 � FAX 425-257-8857 � (E) everetteps@everettwa.gov � www.everettwa.gov/permits � �� :PROJECT SITE INFORI�AaTlON ,r '�� t .��,��. .�, � ,�:.� 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: -e � � ELECTRICAL`APPLICATION INFORMATION ` `h` CONTRACT PRICE OF WORK: $ � NUMBER OF DEVICES (if low voltage): FIRE ALARM? ❑YES [�NO ASSOCIATED BUILDING PERMIT#(if applicable): DESCRIPTION OF WORK: �W{�� ,�� U 1 li CONTACT 1NFORMATION = OWNER NAME: � � � ENANT NAME(If Commercial): ' OWNER MAILING ADDRESS: sTReer � 1� � U CITY � STATE ZIP -V 3 OWNER PHONE: OWNER EMAIL: CONTRACTOR NAME: CONTRACTOR ADDRESS: srREEr s S � CITY ,�� ,�j STATE ZIP � CONTRACTOR PHONE: ^- S �j I CONTRACTOR EMAIL:��'/(il CONTRACTOR LIC.#(REQUIRED): � L.y,� 'V � CITY OF EVERETT BUSINESS LIC.#(REQUIRED): �7 _.... .....�. . . .. .. _ _. _ __ . ..__ �,.� M,.� �,. .. _. ... . __ , ..._, .,n.�.�_. .,z._ PRIMARY CONTACT: ❑OWNER �CONTRACTOR ❑OTHER(Please Specify) CONTACT NAME: CONTACT PHONE:' Q ... � "� � � CONTACT EMAIL: i j AGREEMENT.�I hereby certify that l have read and examined this application and know the same to be true and correct. All provisions of la s and ordinances governing this type of work will be completed whether specified 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 construction. That 1 am authorized by the owner of this property to perform the work for which application is made and I comply with the State Contractors Law 18.27 RCW and 296.200 WAC. City of Everett Official Use Only , PERMIT# � �DI E � -� wner/Authorized Ag gnature Da (Revised 9/23/2016)