2104 JEFFERSON PL 2018-07-18 - Laserfiche WebLink

ELECTRICAL PERMIT APPLICATION CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET, EVERETT,WA 98201 (P)425-257-8810 I FAX 425-257-8857 I (E)everetteps@everettwa.gov I www.everettwa.gov/permits PROJECT SITE.INFORMATION PROJECT ADDRESS: )Cy..4 'Q- ey Pt BUILDING AREA(if residential,new construction, remodel,or addition) 17 Log SF BUILDING TYPES- FR-DETACHED 0 SFR-ATTACHED 0 DUPLEX 0 MULTI-FAMILY-#OF UNITS: 0 COMMERCIAL USE OF BUILDING: Res_Av ncp s:r:: ELECTRICAL.APPLICATION INFORMATION ...... CONTRACT PRICE OF WORK:$ ta{ NUMBER OF DEVICES(if low voltage): FIRE ALARM? 0 YES D NO ASSOCIATED BUILDING PERMIT#(if applicable): DESCRIPTION OF WORK: t p3rCkell Atyy ••Qx ,Q15--.)Amp CONTACT INFORMATION OWNER NAME: 1 Qvj7, I)®r i TENANT NAME(If Commercial): OWNER MAILING ADDRESS: STREET \c)I _ t.e- PrS- P( CITY blreir`P - t STATE W(L) ZIP of ��3 OWNER PHONE:3�Q�}-- -1SA:7Ip OWNER EMAIL: l CONTRACTOR NAME: (2, S 4 QQ-'-- I) CONTRACTOR ADDRESS: STREET ALS C eArej-eki- � CITYSTATE Vf60i ZIP q Zhao CONTRACTOR PHONE:I-45-to l D--L.1.2 5 CONTRACTOR EMAIL: ,rn,.(3s hQ -1 n , (owV\ CONTRACTOR LIC.#(REQUIRED): CITY OF EVERETT BUSINESS LAC.#(REQUIRED): q to fcc PRIMARY CONTACT: 0 OWNER ,ONTRACTOR 0 OTHER(Please Specify) CONTACT NAME: �}�v,4 CONTACT PHONE: `.4ac__ Sara i t1 CONTACT EMAIL: ,. -ex( { hF(knq con, AGREEMENT:I hereby certify that I have read and examined this application and know the same to be true and correb--Ail provisions of Ia*s11nd 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 construction. 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 288.200 WAC. City of Everett Official Use Only PERMIT# hi4A $'-'40A)-1 5/j-7/1 F E I ®S-I Owner/Authorized Agent Signature Date (Revised 9/23/2016)