919 105TH PL SE 2018-06-12 - Laserfiche WebLink

ELECTRICAL PERMIT APPLICATION CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET, EVERETT, WA98201 � ORIGINAL (P) 425-257-8810 � FAX 425-257-8857 � (E) everetteps@everettwa.gov � www.evere gov/permits PROJECT SITE INFORMATION 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: ELECTRICAL APPLICATION INFORMATION CONTRACT PRICE OF WORK: $ � NUMBER OF DEVICES (if low volta e : FIRE ALARM? ❑YES ❑ NO ASSOCIATED BUILDING PERMIT# (if a plicable): DESCRIPTION OF WORK: � C,� CONTACT INFORMATION OWNER NAME: TENANT NAME(If Commercial): OWNER MAILING ADDRESS: sTaeer ` � CITY v r STATE ZIP O OWNER PHONE:L � � ' L OWNER EMAIL: , CONTRACTOR NAME: � CONTRACTOR ADDRESS: sraeeT � CITY � STATE ZIP CONTRACTOR PHONE: L � ' � � CONTRACTOR EMAIL: � a CONTRACTOR LIC.#(REQUIRED): C " � h'e CITY OF EVERETT BUSINESS LIC.#(REQUIRED): � � PRIMARY CONTACT: ❑ OWNER ONTRACTOR ❑OTHER(Please Specify) CON,T CT�ME: CONTACT PHONE: - �- � CONTACT EMAIL• � AGREEMENT.�T hereby certify that 1 have r and exa ned this application and know the same to be true and correcL All provisions of laws 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 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 W.4C. City of Everett Official Use Only FEE � � ��`i I PERMI�# � o E i� ��1� - �2l� O r/ Signatur Date (Revised 10/i2/2015)