Laserfiche WebLink
/11°/ —aELECTRICAL PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT,WA 98201 <br /> (P)425-257-8810 1 FAX 425-257-8857 1 (E)everetteps@everettwa.gov www.everettwa.gov/permits <br /> .........:...:::::.:....::..:.: <br /> ,.... ... ....... .: .. .. . .: NFO >,:::::�:,::<:::::.::.:,,,,::;,::::.:::.::::;;::-::::::;:•::::::=..>:;;::-;<:::;;:-,.;;;;;:_::-;;;<:;;:::::::::,:::::,::: <br /> PROJECT ADDRESS: total RUCk.er VVto <br /> BUILDING AREA(if residential,new construction,remodel,or addition) t CAFaU1 SF <br /> BUILDING TYPE:MSFR-DETACHED ❑SFR-ATTACHED 0 DUPLEX 0 MULTI-FAMILY-#OF UNITS: 0 COMMERCIAL <br /> USE OF BUILDING: g.c, Ir1f 0 <br /> ,:! :..E1.. <br /> E <br /> ,hL;A1 ION <br /> IN!ORM A <br /> ON Peg <br /> CONTRACT PRICE OF WORK:$ dvaa . <br /> NUMBER OF DEVICES(if low voltage): <br /> FIRE ALARM? 0 YES ,Erf,10 <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIPTION OF WORK: pan et ( ' a1 , <br /> .... . ............ ..... .:ill <br /> OWNER NAME: Al an �rr r TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: sTREEr �G�Ao }��,[� <br /> cm( E v l A Air STATE WA Zn' q$aOt <br /> OWNER PHONE:L 'Zg)-Sot C) OWNER EMAIL: AtDi Qq Q nye-. corn. <br /> CONTRACTOR NAME: G S 14.0011Q <br /> CONTRACTOR ADDRESS: STREET14 Qq gVf RI;AQ.. <br /> crr EWYQ4-it- STATE WIA ZIP cuo.0( <br /> CONTRACTOR PHONE: `4 �.��0-425-1. CONTRACTOR EMAIL: s or fa y <br /> CONTRACTOR LIC.#(REQUIRED):( 5 ( S4 01.,2,0 CITY OF EVERETT BUSINESS UC.#(REQUIRED):O1Cto <br /> PRIMARY CONTACT: ❑OWNER KCONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: Lias„to -419--1 <br /> SVOL 141-)1 land CONTACT EMAIL:�C ()�1,-n, hp n TI no, 1.„1.AGREEMENT::I hereby certify that 1 have read and examined this application and know the same to be true and cot All provisions oand ordinances governing this type <br /> 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 <br /> local law regulating construction or the performance of construction. That I am authorized by the owner of this property to perform the work for which application is made and I <br /> comply with the State Contractors Law 18.27 RCW and 296.200 WAC. <br /> City of Everett Official Use Only <br /> PERMIT# <br /> �.- 3/ X)il E l 03' lli96- <br /> Owner uthorized Agent Signature Date (Revised 9/23/2016) <br />