2611 MAPLE ST 2018-07-18 - Laserfiche WebLink

4Enr ELECTRICAL PERMIT APPLICATION CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET, EVERETT,WA 98201 (P)425-257-8810 I FAX 425-257-8857 1(E)everetteps@everettwa.gov i www.everettwa.gov/permits PROJECT SITE INFORMATION PROJECT ADDRESS: 2611 Maple st everett 98201 BUILDING AREA(if residential,new construction,remodel,or addition) SF BUILDING TYPE: 0 SFR-DETACHED 0 SFR-ATTACHED 0 DUPLEX 0 MULTI-FAMILY-#OF UNITS: 0 COMMERCIAL USE OF BUILDING: sfr ELECTRICAL APPLICATION INFORMATION CONTRACT PRICE OF WORK:$ 1000 NUMBER OF DEVICES(if low voltage): FIRE ALARM? ❑YES ®NO ASSOCIATED BUILDING PERMIT#(if applicable): DESCRIPTION OF WORK: line volt for ductless heat pump CONTACT INFORMATION OWNER NAME: katrina jimenez TENANT NAME(If Commercial): OWNER MAILING ADDRESS: STREET 2611 maple st c,n everett STATE wa ZIP 98201 OWNER PHONE: 425 441 3230 OWNER EMAIL: katwright89@gmail.Com CONTRACTOR NAME: Blackburn electric CONTRACTOR ADDRESS: STREET 30819 76th ave nw CITY stanwood STATE wa ZIP 98292 CONTRACTOR PHONE: 425 231 6293 CONTRACTOR EMAIL: CONTRACTOR LIC.#(REQUIRED): BLACKE19882PD CITY OF EVERETT BUSINESS LIC.#(REQUIRE : LA bip 211 PRIMARY CONTACT: ❑OWNER 0 CONTRACTOR fa OTHER(Please Specify) axiom hvac CONTACT NAME: CONTACT PHONE: 425 879 5351 daron smith CONTACT EMAIL:daron@axiomnw.com AGREEMENT:I hereby 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 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 t comply with the State Contractors Law 18.27 ROW and 296.200 WAC. City of Everett Official Use Only PERMIT# -) E t goc _O�ZOwner/Aut r gnature ,..._.6,,/, Date (Revised 9/23/2016)