Laserfiche WebLink
Oct 05 16 11:16a p,3 <br /> ELECTRICAL PE�MI� APPLtCATION <br /> CITY OF EVERETT PERMIT 5ERVICES <br /> 3200 CEDAR STREET, EUERETT, WA 98201 <br /> (P) 425-257-8810 � FAX 42�257-8$57 � (E)everetteps@everetiwa.gov � www.everettwa_govlpermits <br /> PROJECT SITE INFORMI4TION <br /> PRQJECT ADORESS: �Q I� —�' Y � ���i�J � <br /> BUILOiNG AREA(if residenlial,new construction, remodel, or addition) 5F <br /> BUILaiNG TYP�: ❑SFR-DE7ACHED �SFR-ATTACHED CI DUPLEX ❑ MUL31-FAMILY-#OF UNITS- � COMMERCIAL <br /> l3SE OF BUILDING: <br /> ELECTRICAL APPLICATION INF�RMAT�ON <br /> CONTRACT PRICE OF WORK: $ �Z S �, �'i�J <br /> N�IMBER OF DEVICES (i�Eow volta e : <br /> FIRE ALARM? ❑YES 1�N0 <br /> ASSOCIATED BUILDING PERMfT# if applicable _ <br /> D�SCRiPTION OF WORK_ 7 �.i��. � C� I S�F'1 C�GQ ✓ I C"v�.-f�G <br /> , , -s r a� ��r-� a� l�-������� � - r�� .��C� � <br /> C�NTACT INFORMATI�N <br /> aWT1ERNAM � �j�' � � 1'�-e( �G(�F� P'1e S TENANTlVAME�IfCommercial): <br /> OWNER MAILtNG ADDRESS: srnF�r �"'� � � -�t�, � �II�. <br /> CITY Ci V�1r� 4 J STATE �� l�� ZIP � �;�v I <br /> OWNER PFIOt�lE: ��' ' �tL-'V' ' � OWNER EMAIL: <br /> CONTRACTOfi NAME: � L, T��-S��L�'VL ��..�'�..��G '� � �-1� <br /> CONTRACTOR ADDRESS: sTa�ET 1--{--I I � 3 ` '�'� � V`'�- V� <br /> ciTr Cl.i� s�✓i � VC.�- srw� �CJ�� ziP � �i'�-�� <br /> COIVTRACTOR PFtONE:u- � - ���-�li�.� CDNTRACTOR EMAIL_ y1G V�G�S��'V1�'1 G� �� GU�' (��/ , V1� <br /> CONTRACTOR LIC.#(REQIlIRED): �G 1'�G'I�J1�l��S�C'-Y\ CITY OF EVERETT BUSINESS LIC_#(REc�UiRED)� LI�'�y- � <br /> PRIMARY CONTACT: ❑ OWNER CONTRACTOR Q OTHER(Please Specify) <br /> CONTACT NAME: -. CON7ACT PHONE: �,�-5 � �j�S -L_� �- <br /> ���S� � � Y ��`� CONTACT EMAiL: '� % <br /> E'1�vG��»�, � Gl � G�%l�'}C���,i�� <br /> AGREE�fENT.-!hereby certify fhat I have read and examined ttris application and know the same to be true and corroct_ All provisrons of laws end orU�nances governirtg lhls t,�pe <br /> of work wiN be completed whefher speci�ed herern or noi. The greniing of a pe�rnit does not presume to give autho�iry to violote or cancel the provrs�ons of any other sfate or <br /> local law regulating constrvctiorr or[he performance ot construction. 7hat!am authorized 6y the owireroithis properly to perform fhe work for which applicatron is made and! <br /> comply wRh the State Gontractors Law 98.27 RCW and 286.200 WAC. <br /> Crty of Everelt Otfrcral Use Only <br /> PERMIT# <br /> � `� ��- 1 ��� - � � E C� - o � <br /> �, � 0 l � <br /> OwnerfAuthoRzed gent SignaWre Date (Revrsed 9/23/2016) <br />