Laserfiche WebLink
tLECTRICAL 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 /> y <br /> PROJECT ADDRESS: �•C�J `��Y ��1 Yfx �- Lxr �C�� v eXy-< <br /> BUILDING AREA(if residential, new construction, remodel, or addition) SF ��rr <br /> BUILDING TYPE: ❑ SFR-DETACHED ❑ SFR-ATTACHED ❑ DUPLEX ❑ MULTI-FAMILY-#OF UNITS: Xsr COMMERCIAL <br /> USE OF BUILDING: <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK: $ 1 a, U0 <br /> NUMBER OF DEVICES (if low voltage): <br /> FIRE ALARM? ❑YES XNO <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DESCRIPTION OF WORK: r-4 ►C_C:e_ n}y n r.. <br /> CONTACT INFORMATION <br /> OWNER NAME: TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET IC 0 `X42- ��l �'� �Cl,r <br /> CITY 'e�J em---e-ki— STATE UDA ZIP <br /> LAD-1 <br /> OWNER PHONE: L� j L D-1 " L{ 'j OWNER EMAIL: <br /> CONTRACTOR NAME: C <br /> CONTRACTOR ADDRESS: STREET a �� Dr y <br /> , (/,,'�� <br /> CITY •— \ C STATE �,,�/'''�' ZIP -L�' IsR <br /> CONTRACTOR PHONE: �O(Q `�}a ' C�Ar-j CONTRACTOR EMAIL: �j�0.rQA- 0��—k C.0 1l !C\1 J CU'r <br /> CONTRACTOR LIC.#(REQUIRED): L-�S C� L°i S �'�jF �� CITY OF EVERETT BUSINESS LIC.#(REQUIRED): C�t�LfC (t <br /> PRIMARY CONTACT: []OWNER [CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: a 0 b LA U5 a <br /> _ <br /> d,�I� CONTACT EMAIL: ,�� <br /> AGREEMENT.T 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 <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/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 /> � <br /> � <br /> PERMIT# <br /> Owner/Authorized AgeAt Signature Date (Revised 10/12/2015) <br />