3614 LOMBARD AVE 2018-05-22 - 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@everettwa.gov � www.everettwa.gov/permits PROJECT SITE INFORM�9;"it'ION PROJECT ADDRESS: l,Q ` � � � 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 APPLICATION INFORMATION CONTRACT PRICE OF WORK: $ NUMBER OF DEVICES (if low voltage): FIRE ALARM? ❑YES O ASSOCIATED BUILDING PERMIT#(if applicable): DESCRIPTION OF WORK: (� V CONTACT INFORMATION OWNER NAME: TENANT NAME(If Commercial): OWNER MAILING ADDRESS: sTRFer � � �,n EVERETT STATE �NA Z�P � OWNER PHONE: OWNER EMAIL:N�A coNTwacTOR NAMe: IN HOUSE ELECTRICAL SERVICES, INC. coNrRacroR a�oREss: STREET 1530 117TH DR SE �,n LAKE STEVENS STATE WA Z,P 98258 CONTRACTOR PHONE: 4Z�J.76O.3ZO3 coNTRAcroR EnnAi�: IHEPERMITS@GMAIL.COM CONTRACTOR LIC.#(REQUIRED): INHOUES9rJZQG CITY OF EVERETT BUSINESS LIC.#(REQUIRED):044�CH PRIMARY CONTACT: ❑OWNER 0 CONTRACTOR ❑OTHER(Please Specify) CONTACT NAME: CONTACT PHONE: [�2�j.76�.32�3 KELSEY coNTacr eMai�: �HEPERMITS@GMAIL.COM AGREEMENT:I hereby certify that 1 have read and examined this application and know the same to be true and correct. A/l provisions of laws and ordinances gove�ning 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 regu/ating construction or the performance of const�uction. That I 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 Officia/Use Only PERMIT# 2-2/. I� E �� '" ��l '- Owner/Authori d Agent Signature Date (Revised 9/23/2016J