Laserfiche WebLink
9 0 <br /> ELECTRICAL 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 I www.everettwa.gov/permits <br /> PROJECT SITE INFORMATION <br /> PROJECT ADDRESS: D -To O'S W <br /> BUILDING AREA(if residential, new construction, remodel, or addition) d �rr�� SF <br /> 11L] E] 0 <br /> BUILDING TYPE: SFR-DETACHED SFR-ATTACHED DUPLEX MULTI-FAMILY-#OF UNITS:�� ❑ COMMERCIAL <br /> USE OF BUILDING: 417 27 S(f (c - y hfik)" <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK: $ D , v <br /> NUMBER OF DEVICES (if low voltage): <br /> FIRE ALARM? ❑YES NO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIPTION OF WORK: ADD cc rCv-) AU OQT -b-E \J (C <br /> CONTACT INFORMATION <br /> OWNER NAME: ( TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET <br /> CITY STATE ZIP <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: <br /> CONTRACTOR ADDRESS: STREET <br /> CITY :`�T STATE /h ZIP �ILcqF <br /> CONTRACTOR PHONE: 3( c) 6(9 I -2 CONTRACTOR EMAIL: AMPS >,k,J C �7,z iC (OAA <br /> CONTRACTOR LIC.#(REQUIRED): i;J LgJh.: (GS CITY OF EVERETT BUSINESS LIC.#(REQUIRED): 015D D� <br /> PRIMARY CONTACT: ❑OWNER CONTRACTOR ❑ OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: 5�nC7 j �7 C <br /> —! �S C I\ �} 1s U !V CONTACT EMAIL: SAS <br /> AGREEMENT..Thereby certify that I have read and examined this application and know the same to be true and correct. All provisions of laws and ordinances governing this <br /> 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 <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 /> FEE <br /> PERMIT# <br /> E <br /> Owne Authorized Agent Signature Date (Revised 10/12/2015) <br />